
Glass K Bf)"5 
Book .©4^r _. 



p 

UMNO-PATHOLOGY; 

OR 

THE UEOSOOPI AN SYSTEM 

OF 

DIAGNOSING DISEASES, 

BY 

OCULAR INSPECTION, CHEMICAL ANALYSIS, 

AND MICROSCOPIC EXAMINATION 

OF THE URINE; 

ACCOMPANIED BY 

AN ILLUSTRATIVE CHART 

OF URINARY DEPOSITS, 

REPRESENTING THE MICROSCOPIC APPEARANCE OF MORE THAN 

SIXTY DIFFERENT VARIETIES OF INGREDIENTS 

FOUND IN THE URINE. 



By L. OLDSHUE, M. D., 



Professor of Pathology i\ the Eclectic Medical College of Phila- 
delphia, and Member of the American- Eclectic Medical 
Society of Philadblph] v. 



PITTSBURGH : 

D i'v a. a. ANDERSON .v sons, No*. 67 *n» otf FIFTH STREET, DISPATCH BUILDIHQI 

1864. 



Entered according to Act of Congre33, in the year 1S64. 

By L. OLDSHTJE, M. D, 

In the Clark'a Office of the District Court for the Western District of Pennsylvania. 



2 6 6 4 



RECOMMENDATION. 



From time immemorial, physicians have examined with more or less 
attention the renal secretion, with the view of better understanding morbid 
conditions of the human system. Very general directions, with only here 
and there a few particular cases, have slowly crept into our medical text- 
books, until very recently. 

Of late the attention of* the medical world has been called to the sub- 
ject in two different ways, to-wit : 

1st. Practically, by the practice of what is called Uroscopia. 

Uromantia, or the art of diagnosing diseases by the simple inspection of 
the urine, has not been practiced exclusively in this country ; still, many of 
the most learned in the Profession have paid considerable attention to the 
Mibject. 

In the Germanic States, it is affirmed by some, to be better understood. 
In this way our empirical knowledge was of a practical nature, which 
scientific analyses must render more definite and intelligible. 

2d. Valuable scientific treatises have lately appeared, demonstrating, be- 
yond a doubt, that even empirical claims fall far short of facts. 

Now, by the aid of these works, united with the experience of practi- 
cal Uroscopians, a very important addition to our present stock of knowl- 
edge, might be embraced in a scientific work on Uroscopia. Its importance 
and practicability has been ably set forth in a series of articles from the pen 
of Dr. Oldshue, of Pittsburgh. He is presenting to the reader the Urosco- 
pian System, as he was taught, and as he has practiced it, though not 
exclusively, but as an important auxiliary, to correct diagnosis. It is a 
subject which invites investigation, and which promises valuable practical 
reward for careful researches. Dr. Oldshue has presented us with a mass 
of testimony attesting the value and importance of understanding this sub- 
ject, quoting the opinions of those who rank first as medical investigators. 

We can not here omit noticing an incidental remark of Prof. Buchanan, 
relating to the intimacy sustained between all the secretions, and especially 
ilte renal, and the condition of the brain. It is presumed that he under- 
stands the subject of physiology, not only, but is familiar with the opinions 
of physiologists. He says : 

" It is regarded by physiologists as an established truth, thai the action 
of the brain, as well as even other organ oi' the constitution, is accompa- 
nied by chemical changes in its substance, consisting oi' the disintegration 
of the nervous matter, and the nutritive deposit oi' the freshly-assimilated 
particles of the blood, it has been ascertained that these changes are ac- 
companied Im corresponding changes in the secretions, and that the kid- 
neys, of all organs, appear to sustain the most intimate relation to 
brain." 



iv Recommendations. 



Put these remarks (says Prof. 0. Davis) beside the clinical statistics fur- 
nished by the General Hospital, at Vienna, according to the testimony of 
Prof. White, and we see this ''established truth" is so considered by those 
for whose opinions we entertain respect. 

Dr. Oldshue is doing a valuable work, and Ave hope to receive many 
more articles from his pen on the Uroscopian System. 

Rochester, December, 1851. 



OPINIONS OF THE PRESS. 

" Dr. Oldshue is a graduate of the Reformed Medical College, and has 
sustained an excellent character as a man, and is devotedly attached to his 
profession, and attentive to his business." — M'Keesport Standard, 1856. 

" Dr. Oldshue, a number of years since, practiced Medicine in this county, 
and is well and favorably known to many of our citizens. He has acquired 
considerable notoriety for his success in treating diseases." — Connellsville 
Enterprise, Fayette Co. 

"He has acquired a large reputation for his successful treatment of dis- 
eases, and commands an extensive practice." — Wellsville Patriot, 0. 

" He has become a perfect master in his profession, and by a careful study 
of the Uroscopian System, has, by a series of experiments and years of prac- 
tice, acquired such a ready knowledge as to enable him to detect the most 
complicated case, by an examination of the urine." — Greensburg Herald. 
Westmoreland Co. 

" He is a regularly educated Physician of over fifteen .years practice, ten 
years of which time he has been in Pittsburgh, where he is well and 
favorably known, both by the people and the Profession, and, as we learn 
from the patients themselves, has been very successful." — Independent Ban- 
ner, Clarion Co., 1856. 

" He has acquired a well deserved reputation for the cure of the worst 
maladies known to the human system. His treatment is both safe and ef- 
fectual, and has produced the most astounding results. We have this from 
some of the most respectable persons in our county, who have sent to him 
from this place." — Waynesburg Eagle, Greene Co. 

"We are well acquainted with the treatment adopted by Doctor Oldshue, 
as well as the successful results which have so uniformly attended his pro- 
fessional labors." — Indiana Independent, Indiana Co. 

" He treats all kinds of diseases. His study and knowledge of the 
Uroscopian System, enables him to treat cases from a distance, by an exam- 
ination of their urine. He has in this respect been more successful than any 
Physician within our knowledge." — Brookville Jeffersonian. 



Recommendations. 



u In Medical Practice, as in everything else, the best test of a Theory is 
its practical results. The success of Dr. Oldshue, during a Practice of 
ten years in Pittsburgh alone, affords sufficient evidence of professional 
skill and ability." — Blairsville American , Indiana Co., 185G. 

" Fifteen 'years practice, assisted by close study, as is the course of the 
Doctor, places him in no subordinate position in the line of his profession." 
— Wellsville Patriot. 

11 He is a gentleman in every respect qualified for his position. His 
career in the line of his profession has been a successful one, and he has 
seldom failed to both relieve and cure his patients." — Connellsville Enter- 
prise. 

11 An improvement has been effected in the treatment of diseases under a 
Progressive and Reformed System of Medical Science ; and Dr. 0. has added 
more perhaps to this reform than any man in the "West. He treats all kinds 
of diseases ; and his success has been almost universally attended with the 
most satisfactory results." — Columbian Republican, 0. 

" He is not unknown to many of our citizens, numbers having visited him 
from this place for professional relief. Testimonials from different parts of 
our county, attest his success in curing different diseases of a difficult and 
complicated character." — Clarion Democrat, Clarion Co. 

" He is well acquainted with all the late improvements in the treatment of 
disease ; and also understands the Uroscopian System, and those from a dis- 
tance, who can not attend him personally (a vial of urine being sent him |, 
will receive a thorough examination, and medicines can be sent them." — 
Armstrong Democrat, Armstrong Co. 

"He treats all kinds of diseases common to the human system, and is 
thoroughly studied in all the modes of practice. The writer of this, within 
the past year, has visited the principal Medical Institutions in Philadelphia, 
and Cincinnati, and uniformly heard but one opinion expressed of the gen- 
tleman in question (viz. : Dr. Lincoln Oldshue), and that was, of unquali- 
fied approbation of his great medical research, as well as his honest and 
honorable mode of Practice." — From the Pittsburgh Union. 

" Dr. L. Oldshue, Who for the last, ten years has been located in Pitt- 
burgh, formerly practiced Medicine in our county, and is well known to 
many of our citizens, lie is a regular graduate in his profession, and the 
best evidence of his skill is his acknowledged success, which as we under- 
stand, from the patients themselves, thai have visited him from thisplacej 
has been remarkably good." — Genius of Liberty, I 

" He is well and iavorobly known to most of our readers, and is a gentle- 
man of talent, experience and ability, and a successful physician in all he 
undertakes." Washington Revieio, Washington Co. 

M He has a. good practice, and is worthy oi all confidenc . 
LS known the more he will be esteemed and employed." 



Chronicle. 



vi Recommendations. 



WORTHY OPINIONS. 

" The objection often urged against the possibility of a minute acquaint- 
ance with urinary deposits being available in practice, no longer exists ; a 
minute or two being sufficient for the observer to learn the nature of anv 
variety of sediment." - GOLDING BIRD, A. M. ? M. D. * 

" We can arrive at a more accurate knowledge respecting the nature of 
diseases from examining the urine, than from any other symptom." 

DR. BRAITHWAITE— Retrospect. 

u Whatever may be the disease, the urine seldom fails in furnishing a clue 
to the principles upon which it is to be treated." — EberWs Therapeutics. 

11 The different conditions of the urinary discharge, seems to indicate a 
corresponding difference in the constitutional affection, to which they be- 
long ; and we entertain hopes, that hereafter, and under a more accumula- 
ted experience, they may be found important guides in practice." 

JOHN BLACKALL, M. D. 

" The importance and practicability of a scientific work on Uroscopia, has 
been ably set forth in a series of articles from the pen of Dr. Oldshue, of 
Pittsburgh. He is presenting to the reader the "Uroscopian System" as he 
was taught and has practiced it, as an important auxiliary to diagnosis." 

PROF. 0. DAVIS. 

" The great impulse that has lately been given to the study of Chemical 
Pathology has thrown considerable light on many obscure subjects. The 
Urinary Secretion is the chief, and at the same time the most important sub- 
ject of attention in this branch of science." — Markwick on the Urine. 

" From the physical and chemical state of the urine, the attentive, ob- 
serving physician, may obtain a great quantity of information for ascertain- 
ing and establishing a diagnosis. More than all other signs, the correct 
examination of the sediment is of importance to the physician." 

DR. F. SIMON. 

" The examination of the Urine in disease is noAv regarded as one of the 
most important aids in diagnosis, and which it would be alike injurious 
to the welfare of the patient, as to the credit of the practitioner to avoid." 

DR- G. BIRD. 

"Dr. Oldshue is presenting us with a mass of testimony, attesting the 
value and importance of understanding this subject, and doing a valuable 
work. We hope to receive many more articles from his pen on the " Uros- 
copian System."' — Eclectic Journal of Medicine 

"To argue that such investigations are idle, are as absurd as unfortu- 
nately they are frequent. But there is, however, one consolation in this 
matter, which is, that those who are most ready to urge this view, and to 
decry its utility, are such as are least acquainted with its detail." 

J.W. GRIFFITH, M. D..'F. 1!. S. 



INTRODUCTION, 



Although the various diseases which are prevalent in our 
country appear to be sufficiently defined by our medical authors, yet 
no observing practitioner can have had much experience at the 
bedside of the sick, without frequently finding it peculiarly diffi- 
cult, and ofttimes impossible to ascertain the precise nature, extent, 
and locality, of the diseases he is required to combat. 

These difficulties are acknowledged by all medical authors, and 
experienced practitioners, and it has been the opinion of some of 
our most able medical men, that a majority of deaths which occur 
when a physician has been timely employed, are occasioned by their 
mistaking the nature of the disease they are required to cure. And, 
should infancy, insanity, idiocy, delirium, hypochondria, paralysis, 
insensibility, or any other cause, prevent the patient from describ- 
ing the symptoms, the difficulty of determining its nature is very 
much increased. 

With a knowledge of these facts, we, therefore, through the 
whole course of our study and practice, in addition to the regular 
means, have paid particular attention to that branch of medical 
science called Uroscopia, or the detection of diseases by an exami- 
nation of the urine, our medical duties being constantly brought 
under that mode of distinguishing diseases. 

To make pretensions to a new or mysterious ystem of diag- 
nosing diseases, is not the object of this work, but to direct the 
attention to a too much-neglected auxiliary mode ; believing that 
a better acquaintance with its principles will assist in arriving at a 
more intimate knowledge of the nature of the different diseases that 
afflict the human family, and thereby enable OS to calculate a more 
positive method of treatment 



viii Introduction. 



The Uroscopian system is not of recent origin, or at least, the 
practice of analyzing and inspecting the urine, for the better dis- 
crimination of diseases, has long been conducted by many medical 
men. The march of improvement, however, has from time to time, 
developed fact upon fact, relative to the urinary secretion in the dif- 
ferent diseases, which development has given such impetus of late, 
to this growingly, interesting subject, that we have attempted to 
reduce these facts to a more decided form. 

This has been a labor of no little magnitude ; but the ample op- 
portunity of investigating the subject, which it has been our lot to 
enjoy for the last twenty years — having conducted the examination 
of over three thousand specimens of urine, annually, or an aggregate 
of over fifty thousand cases — we feel justified in this effort to sys- 
tematize the course, and hope to be able to present such facts, and 
exhibit such principles and rules, for the examination of the uri- 
nary secretion, that a more accurate diagnosis of nearly all forms 
of disease may be thereby deduced with more nearly mathematical 
precision than can possibly be done without. These principles and 
rules, when thoroughly understood, will many times conduct the 
practitioner through the most complicated cases, to the most mi- 
nutely correct conclusions ; for, as in the English language, which 
comprises more than sixty thousand words, all of which are dis- 
tinctly divided into a few classes, or parts of speech, and are all gov- 
erned by a set number of rules, whereby each particular word in the 
whole vocabulary is not only referred to its class, but is distinctly 
assigned to its own particular place in the millions of sentences 
which are comprised in the language, so with the principles and 
rules which govern the examination of urine in diseases ; by these, 
each specimen of urine may not only be referred to the class of 
disease to which it belongs, but may be traced to its division or 
subdivision, and even assigned to its own particular place in the 
series. 



Introduction. ix 



Life is a peculiar property uf organic matter, of which we know 
nothing, but from the phenomena it displays in an organized body. 
All organized bodies have a limited existence of form, however, and 
pass through certain ages, the terminations of which are called 
death ; and anything which reduces these limitations, or cuts short 
these ages, may be termed disease — the antagonist of life. 

Disease is strictly an activity. Its first appearance is the first of 
a series which in the nature of things is continually progressing. 
Therefore, so long as the antagonism of vitality and disease exist in 
any subject, there will be antagonistic series going on. Each disease 
is a series of itself, and each particular form of disease, one only of 
its series, these series being of every gradation from the slightest 
predisposing influence, to the complete destructien of the age of the 
existence, or ,life. 

This antagonist of life manifests its attack upon the body first, 
in the blood, then upon other parts, in a variety of ways. x\nd in 
whatever way, the urine soon takes on the characteristic indications 
either in optical appearances, chemical composition, or microscopic 
characters, or all of these together. 

To facilitate the labor of the study of its microscopic character, 
we have prepared a Chart to accompany the work, arranged in the 
most perfectly scientific order; its divisions, lettering and artistic 
workmanshih, being the most complete, systematic and convenient. 
of any now in use, as a single glance at it will show. 

For the facts in elucidating the "general principles," as also in 
determining special diseases and causes, we have drawn largely upon 
the researches and labors of Bird, Reese, Markwick, Bowman. 
Bennet, Andral, Prout, Griffith, Beach, Paine, Newton, Simon, Wil- 
liams, Wilson, Taylor, Bartlett, Wood, aud a number of others, where- 
ever their observations accorded with our own. 

The urine being composed of such parts of the human system M 

have been wornout or diseased, and can no longer remain therein, 

without detriment to its healthy operations, together with the sti'.vr- 
2 



Introduction. 



fluous matter collected from every part of the system and transmitted 
to the blood, and separated therefrom by the kidneys (-'the grand 
drain established by nature for purifying the system of superfluous 
or unhealthy matter") , it is rational to examine that secretion in 
disease to ascertain the healthy and unhealthy operations that are 
thus going on. 

Again, if any part of the system becomes diseased, its vitality, of 
course, is lessened, and consequently that part has less power to re- 
sist the tendency to decomposition; hence, there will be more of this 
diseased substance or wornout particles, passed from this diseased 
part, than from the healthy parts of the system, at the same time. 
And, as the different parts of the system are of different composition, 
colors, consistency, etc., so much so that almost any person can dis- 
tinguish merely by their appearance, the lungs from that of the 
heart, liver, stomach, kidneys, brains, etc., or one of them from 
another, so the refuse fluid, or wornout or diseased particles of these 
parts, are also different one from another; therefore, it is plain that, 
if any organ gives out moro than its customary share, it will alter 
the general properties and composition of that fluid whereby it is 
carried off. 

Now if these facts be true (and for their confirmation we appeal 
to our medical authors, and such of our medical men as understand 
the pathology of diseases), every different disorder will impart its 
own peculiar stamp to the urine, and we need only know what that 
peculiar stamp is, to pronounce upon the nature, extent, and char- 
acter of the disorder, with almost undeviating certainty. 

Nor is this mere idle theory; for although the subject has at- 
tracted but little attention for years, and has been almost neglected 
in general practice, yet all our most celebrated authors, Cullen, Good, 
Gregory, Dewees, Dunglinson, Eberle, Beach, etc. etc., unite in as- 
cribing to almost every disease of which they treat, a characteristic 
appearance of the urine. And hence, when we consult medical au- 
thors the above opinion is confirmed. 



Introduction. zi 



And when we consider the structure of the human system, the 
composition and circulation of the blood, the peculiar chemical 
changes in that fluid in disease ; and the nature, composition and 
origin of the urine, with the ahemical changes and different appear- 
ances, consequent upon the changes in the blood, we are induced to 
pronounce unhesitatingly, that, it is a valuable test for distinguishing 
disease. And yet it has long been a matter of toonder to some medi- 
cal men, how anything like a correct diagnosis of any disease can be 
made from the inspection or examination of the urine. This wonder 
ceases, however, as they become more practically acquainted with all 
the varied chemical Qualities and characteristic appearances of that 
fluid as voided in the different classes and varieties of disease. 

To become so acquainted has hitherto been a matter of very diffi- 
cult accomplishment, in consequence of the confusion through which 
the system has been laboring, for want of being reduced to a syste- 
matic form. The very limited knowledge of it, as taught in our 
medical schools, seldom renders the student capable of applying it, 
beyond a mere auxiliary in urinary diseases, that being the extent to 
which observations are generally made on this subject. 

We claim, however, to have made further investigations upon this 
subject, which investigations have demonstrated to us the facts, that 
every class of disease communicates its separate and distinct charac- 
teristic appearance ; and every particular disease, its own peculiar 
stamp to the urine ; and that these investigations and the discovery 
of these facts, have enabled us to lay down certain rules for the ex- 
amination of that secretion, whereby these peculiar qualities and 
characteristics may bo almost invariably detected; and thereby to 
determine not only the nature of the disease, but even to form a very 
correct opinion as to its extent also, from a mere inspection of a spe- 
cimen of urine voided at the time. 

We claim more: we claim to have so arranged this system, as to 
be able to teach it to students with as much success and general satis- 



xii Introduction. 



faction, as is given in surgery, materia medica, or the practice of 
medicine in general. 

For the convenience of such teaching, as well as for the more cor- 
rect application of the principles to general practice, we have reduced 
the system to a prescribed form, regulated according to certain general 
rules. 

First, then, is the classification. For, as diseases are very readily 
divided into classes, each class having its own peculiar characteris- 
tics, whereby it is readily distinguished from others, so is the urine 
naturally classified, as separately and distinctly as are diseases them- 
selves. Each different class of disease, as before observed, commu- 
nicates its characteristic trait to the urine, and each particular variety 
of disease imparts its peculiar stamp to the same; hence we will at 
once observe, that by first classifying the urine according to these 
characteristics, then particularizing according to these peculiar stamps, 
we will have no difficulty in arriving at the precise nature of the 
malady. 

By this arrangement we are enabled, almost at first sight of a spe- 
cimen of urine, in nearly every instance, to determine the class to 
which any such specimen, and consequently, the disease, belongs — 
whether inflammatory, febrile, eruptive, dropsical, nervous, etc., even 
without asking a single question concerning the patient. 

When the class is thus determined, a note of the same is taken down, 
and a search instituted for the peculiar stamp, whereby the variety of 
the class is characterized. If we find ourselves unable to detect, by 
ocular inspection, the characteristics indicating the more particular 
disease, the specimen is then submitted to the most convenient appro- 
priate chemical test, in the selection of which test we are governed, 
and generally very correctly too, by the class also, this being the 
index to the farther investigations, which enable us to determine 
more precisely the malady. 

When this is done, the specimen of urine is carefully sealed up, 
and preserved for re-examinations by our students; and bo we con- 



Introduction* xiii 



tinue to collect and preserve all the important specimens, until a 
cabinet of several hundred of every grade and variety is gathered 
together. 

Each specimen is labelled according to its class, and also numbered 
according to its peculiarity or variety, such numbers being severally 
noted down in a book kept expressly for the purpose, which notes 
serve as a guide to the students, in the numberless re-examinations 
and comparisons of specimens one with another, which are necessary 
to a perfect knowledge of the science. For, like the practiced 
ear to music, which is enabled by the constant exercise of the 
sense of hearing to detect the most minute discord in the most intri- 
cate piece; so, by the oft-repeated, or continual exercise of the fac- 
ulties upon this subject, they are rendered so acute as to detect the 
difference in the most difficult and complicated cases. 

These daily re-examinations and comparisons of several hundred 
specimens, together with the daily accessions of new cases, which are 
constantly being brought to a practical Uroscopian of reputation, 
can not fail to teach him something that is not to be learned by a few 
observations alone. 

Hence, having observed that it requires a greater number of ex- 
aminations than generally comes under the notice of medical men, 
who make no pretensions to a knowledge of this branch of the pro- 
fession, to enable them to come into full possession of a thorough 
knowledge of this science, we will readily see the advantages of our 
plan and course of study. 

The student must persevere beyond a few experiments alone, and 
must look through premises to conclusions, and must conduct his 
experiments and investigations through the whole classification, be- 
fore he will be enabled to draw any pathological deductions. When 
he is able to classify the urine in accordance with the disease, he 
then has hold of the key, as it were, which unlocks to him the door 
to farther investigations, by persevering in which, the UroSOOpiAB 
system will be developed to his pleasing satisfaction. 



xiv Introduction. 



The system must be thoroughly understood before it can be prac- 
ticed at all. No one can succeed without. An attempt of anyone 
to palm himself upon the community as a practical Uroscopian, with- 
out a thorough knowledge of its principles, would discover him per- 
haps, in the very first case presented for examination. His failure 
to at once detect and describe the disease, would exhibit his igno- 
rance, and drive him from his false position. 

It would be impossible for any person, however shrewd a Yankee, 
or apt in the "art of guessiDg," he might be, to pronounce at once 
the precise nature of the disease, in a sufficient number of cases to 
acquire a reputation. And, a single failure in any case, would almost 
be utter ruin, so incredulous are the community on this subject. 

Besides, the patients themselves in many cases are good judges of 
their own aches and pains, and can tell at once whether their symp- 
toms have been described or not. And on the other hand, if they hear 
proclaimed with certainty the organ or organs affected, and the true 
nature of the disease and all the attending symptoms fully described, 
they see at once the positive application of the system and are struck 
with astonishment at its correctnees; and hence it is, in part, that a 
good business is always secured by a practitioner of this class. Not 
only has he the advantage of a more complete knowledge of the dis- 
ease, but a clue at the same time is given to the treatment thereof; 
and thus a twofold advantage is derived : the patient in his chances 
of recovery, and the practitioner in point of success. 

To show that we are not claiming too much for our system when 
we propose to make it an auxiliary of great value, in dingnosiog 
many diseases, we will exhibit the opinions of several medical authors 
who rank high in the Profession, Eberle, Prout, Braithwaite, Golding 
Bird, and Simon. 

Prof. Eberle, says, "The urine being secreted from the blood 
during morbid vascular excitement, the substance with which the 
blood is surcharged, together with the substances cast from the 
excited organs will be imparted to the urine. The appearances 



Introduction. xv 



and character of the urine often afford valuable diagnostic indica- 
tions. We find, too, that the solution of diseases is more frequently 
attended by a critical discharge of urine than by any other of the 
excretions." 

Dr. Prout, says: "The appearances of the urine were at one time 
regarded as of the utmost consequence in forming a proper opinion 
of the character of diseases. At present, this secretion is too much 
neglected ; by an attention to it, we will often be greatly aided in 
our judgment of the nature of the diseases. Grenerally speaking, 
nothing can be more opposite than the conditions of the system, and 
consequently, the principles of practice indicated by a diminished or 
increased flow of urine. Hence, they are symptoms of primary im- 
portance in all diseases in which the urine is concerned ; and what- 
ever may be the disease, seldom fail of furnishing us with a clue to 
the principles upon which it is to be treated." (Vol. 2, Eberle's 
Therapeutics). 

Prof. Braithwaite says : " We can arrive at a more accurate 
knowledge respecting the generality of diseases from examining the 
urine, than from any other symptom." 

Golding Bird, speaking of the morbid conditions of the urinary 
secretion, says that we are to regard them as one of a series of 
pathological changes going on in the system, and more valuable than 
others as an index of disease, in consequence of the facility with 
which it is detected ; that the urine pumps off any excess of fluid 
that enters the circulation and causes disease. 

Dr. Simon says : (i There is not a more important sign offered in 
disease, than in the urinary secretion." 

Hundreds of others might bo referred to, bearing equally valuable 
testimony in its favor ; many of whom will be quoted in the body of 
this work, whose opinions will add weight to the truths it contains, 
and assist in convincing many of the facts that, of all the means of 
determining the precise nature and extent of diseases, none other is 



xvi Introduction. 



so universally to be depended upon, and none so easily and satisfac- 
torily accomplished. 



EREATA. 



On page 31 line 24, for E. C. F., read E. and F. 

" 47 " 10, for rapidity, read respiration. 

" 67 " 5, for in blood, read of the blood. 

" 87 u 21, for exertion, read excretion. 

" 137 " 19, for decreased, read diseased. 

" 153 " 13, for from two, read from one to two. 

" 156 " 20, for caeries, read caries. 

" 176 " 4, for Arnold, read Andral. 



(JRINO-P ATHOLOG Y; 

OR, 

THE UIIOSOOPIAN SYSTEM 

OF 

DIAGNOSING DISEASES. 



Simon in his "Chemistry of Man" divides the proxi- 
mate constituents of the animal body into two great classes, 
the Mineral and Organic. The Mineral Constituents he 
classes in three groups comprising 1st, those which are of 
service in the animal body in consequence of their physical 
properties; 2d, those which effect important objects in the 
system by their chemical actions ; and 3d, those which, being 
only incidentally present, may be eliminated without exerting 
any unfavorable effect on the economy." 

In the first group, and first in the importance of its phys- 
ical properties to the animal organism is ranked Water. 

Second in importance to water, is ranked Phosphate of 
Lime, or bone-earth, as occurring in bone, blood, milk, urine 
and faeces. 

Third in rank is placed Carbonate of Lime, as forming the 
principal part of the skeleton. 

Fourth, Phosphate of Magnesia, as being frequently asso- 
ciated with phosphate of lime, and occurrng in bono, blood, 
milk, urine, faeces, concretions, etc. 

Phosphate of Magnesia and Ammonia, or as it is fre- 
quently termed, Ammoniaco-Magnesian Phosphates, is given 
as a distinct salt, which is present in certain states of the 
urine. 

And last, Fluoride of Calcium, as occurring in the animal 
organism in minute quantity. 



18 Urino-Pathology. 



In the second group, the first importance is given to Hy- 
drochloric Acid, as being useful by its chemical properties. 

The second in importance is Hydrofluoric Acid. 

Third, Chloride of Sodium. 

Fourth, Carbonate of Soda. 

Fifth, Phosphate of Soda. 

Sixth, Chloride of Calcium. 

Seventh, Chloride of Iron. 

Eighth, Iron, as being the principal coloring matter of the 
blood. 

In group third, the incidental constituents are placed in the 
following order: 

First, Chloride of Potassium. 

Second, Alkaline Sulphates. 

Third, Carbonate of Magnesia. 

Fourth, Manganese. 

Fifth, Silica. 

Sixth, Allumina. 

Seventh, Arsenic. 

Eighth, Copper. 

Ninth, Lead. 

Tenth, Ammoniacal Salts. 

While each of these have been considered as proximate 
constituents of some part of the animal body, nearly all have 
been found in the urine, either as useful, or an incidental 
constituent of that fluid. 

The Organic constituents are arranged in two principal 
groups — the Nitrogenous and the Non-Nitrogenous matters. 

First in importance of the Nitrogenous constituents, is 
placed Protein. 

Under the head of Protein, three very important com- 
pounds are considered ; compounds which are found to con- 
stitute the greater part of the animal body. These are Al- 
bumen, Fibrin, and Casein. 

The name Protein, which signifies "lam first," is regarded 
as the starting-point of all the tissues. And it is said that 



TJrino-Pathology. 19 



Protein, in every respect identical with that which forms the 
basis of the three aforesaid animal principles, may be obtained 
from similar elements in the vegetable kingdom. 

There is Vegetable, Albumen, Vegetable Fibrin and Vege- 
table Casein, and a the chemical analysis of these three 
substances has led to the very interesting result that they 
contain the same organic elements, united in the same propor- 
tion of weight ; and what is still more remarkable, that they 
are identical in composition with the chief constituents of 
blood, to-wit : animal fibrin and albumen." 

Second in importance ranks Albumen, which is but a modi- 
fication of protein, and occurs in large quantity in all the ani- 
mal fluids that contribute to the nutrition of the organism. 

Third in importance ranks Fibrin, which is but a modifica- 
tion of the first, also. 

Fourth is Casein, which substance constitutes the most 
important ingredient in the milk of the mammalia. 

Fifth in order is Pepsin, a substance which constitutes the 
most essential portion of the gastric juice. 

Sixth, Ptyalin, a peculiar animal matter that exists in the 
saliva. 

Seventh, G-elatin. This does not exist as gelatin in the 
animal tissues, but may be formed from them by the action of 
boiling water. 

Eighth, Pyin, a peculiar substance which occurs in pus. 

Ninth, Extractive Matters, an amorphous mass of organic 
nitrogenous matter which remains after the protein compounds 
and the salts have been removed from the animal fluids. 

Tenth, the Coloring Matters of the blood, bile and urine, to 
wit: Hematin, Biliphin, and Uroerthyrin. 

Eleventh, Bilin, the most important constituent of bile. 

Twelfth, Urea, the principal constituent of the solid residua 
of normal human urine. "It is found in considerable quanti- 
ties in the blood after extirpation of the kidneys, also in cer- 
tain pathological conditions in which the renal functions are 
not properly discharged." 



20 Urino-Pathology. 



Thirteenth, Uric Acid, a constituent of the urinary secre- 
tion in apparently all classes of animals. 

Fourteenth, Hippuric Acid. This is said to sometimes occur 
as an ingredient in healthy human urine. It is readily ob- 
tained, however, from the urine of the horse or cow. 

Fifteenth, Uric Oxide. This is said to be an ingredient in 
severe cases of vesical calculi. 

Sixteenth, Cystin. This is an occasional constituent of the 
urinary secretion, and is sometimes found as a crystalline de- 
posit, especially in scrofulous and cachetic diseases. 

These are the Organic Nitrogenous constituents of the ani- 
mal body numbered in the order of their importance. 

Next comes the Non-Nitrogenous, and the most important 
among these stands — 

First, Animal Sugars. Sugar of milk is an important con- 
stituent of the milk of the mammalia. 

Second, Fats. Under this head is included "the various 
Non-Nitrogenous compounds, which are insoluble in water. 

Third, Acids. Under this head is included Lactic, Ox- 
alic and Acetic Acids. 

Lactic Acid is regarded by most chemists as a constituent 
of almost all the fluids of the animal body. 

Oxalic Acid is not considered one of the normal constit- 
uents of the animal organism, but is a very common ingredi- 
ent of morbid urine when combined with lime, and in the 
form of Oxalate of Lime, is found in the urine in dyspep- 
sia, etc. 

Acetic Acid has been found by Tiedeman and Gmelin in 
the gastric juice, and is asserted by some chemists to be a 
constituent of urine. 

These are the proximate constituents of the animal body — 
Mineral and Organic ; and while the study of the variations 
of these would give most important information, the limits 
of this work make it expedient for us to confine ourselves 
to this mere relation of them at present. It will be observed 
that a large number of these perfectly distinct substances enter 



Urino-Pathology. 21 



into the composition of the blood and urine. And as the 
examination of the variations in the urine, in relation to 
pathological conditions, is the object of our labors, we will 
be confined more particularly to these. 



EXAMINATION OF URINE. 



There are three prominent modes whereby the urine 
may be profitably examined for the better discrimination and 
more correct diagnosis of many diseases. 

First — OPTICALLY only. Noticing its transparency, opac- 
ity, fluidity, turbidity or limpidity : Whether it be colorless, 
amber, saffron, red, yellow, brown, olive, green, blue, black, or 
tinged only with either ; whether pale, bright, deep, scarlet, 
crimson, dingy, or blood-red color ; whether straw, orange, ash, 
icteritious, or clay-colored ; whether chesnut, reddish, yellow- 
ish, greenish, bluish, or blackish-brown color ; whether pale, 
deep, dark, apple or sea-green color. And so of every shade 
of color and of all mixtures of colors, from the milk-white, 
down to the muddy, dirty-water-like, blackish-brown urine of 
putrefaction. 

In this examination you will also observe whether it be 
clear, cloudy, ropy, thick or muddy. 

If cloudy, whether it coagulates in a sheet or table in the 
center of the vessel, rises to the top, or falls to the bottom 
of the urinal ; whether it throws up a cream-like pellicle to 
the surface, deposits a sediment at the bottom, or crystalizes 
on the sides of the vessel. 

All these have their diagnostic importance, and each ex- 
presses a significant fact of great value, in the progress of 
examinations, and many times, alone throw a flood of light 
upon the nature of the case. 

The principal coloring matters of the urine are, however, 
generally few, and of very easy determination. "Where but 
one coloring matter is present there will be but little diffi- 
culty to decide, but in the combinations which so variously 
occur, we may sometimes be considerably perplexed. We 
will here notice some of the most common, with their pecu- 
liarities and qualities. 



Urino-PatJiology. 23 



Purpurine, is a peculiar coloring matter which is always 
combined with urate of ammonia, and varies in tint from a 
mere flesh color to the deepest carmine. It was thought by 
some to be identical with murexid or purpurate of ammonia. 
"It merits considerable notice/' says Bird, "from the seri- 
ous lesions its presence frequently indicates. " "When pres- 
ent in urine, it will often communicate to it so intense a color, 
as to cause the patient to report his urine to be bloody." It 
indicates hepatic derangement, affection of liver, spleen, etc. 

Cyanourine, gives a blue color to urine, and deposits in a 
blue powder. Diluted acids dissolve it, however, and change 
it to brown or red, according to the proportion of acid 
present. 

Indigo, which is sometimes found in urine, gives it a dark- 
blue color. 

Hemaphaen, is the yellow coloring matter of urine, "and 
it is probably," says Bird, " to its presence in excess, that 
the jaundiced hue of persons in a state of anemia and chlo- 
rosis is owing." " The normal amber color of urine is prob- 
ably owing to a mixture of this pigment with a red one." 

Oholestrine, is supposed to give the coloring principle to 
bile. It assumes a blood-red color from the action of sul- 
phuric acid. It frequently occurs in a crystalline state in 
animal fluids, in the blood, bile, fluid of hydrocele and ute- 
rine hydatids. It forms the chief ingredient of biliary cal- 
culi. It often gives the urine a deep-brown color. 

Hoematosine, is the coloring matter of the blood, and is the 
most general coloring matter found in the urine also, the 
urine being secreted entirely from the blood, must partake 
somewhat of its coloring matter very general lv. 

This coloring matter varies in urine, from the brightest red, 
to the darkest brown, according to its combination with Other 
substances, and to its excess or deficiency therein. 

Hematoxylin, administered as a medicine, will often, by the 
red color it communicates to the urine, lead to an unfounded 
suspicion of the existence of hematosino. 



24 Urino-Pathology. 



Mucus, pus, milk, fat, etc., all have the effect of changing 
the color and optical appearance of the urine, but may be 
known by their different qualities. 

" The knowledge of urinary disorders," says Dr. Aldridge, 
"has so rapidly progressed within the last few years, as to 
have now arrived at least to a level with other departments of 
medical science, but unfortunately this knowledge is very lit- 
tle diffused among the members of the medical profession." 

As a guide to the learner we would recommend specimens 
of urine to be collected from patients laboring under the 
different diseases, and in fact all different stages of the same 
disease ; carefully preserve the same, not only for comparison 
one with another, but for comparison with new specimens 
that may from time to time be added. 

A cabinet of several hundred of these specimens, compris- 
ing as they might do, urine from every grade and variety of 
disease, would be of valuable asssistance to the learner, and 
even to the old practitioner it would not be without its im- 
portance in making up his diagnosis in many cases. 

Those who would obtain a knowledge of this important 
branch of the medical art, by pursuing such a course, keep- 
ing in view the age and sex of the patients, having a knowl- 
edge of the appearance and standard properties and qualities 
of healthy urine, as also the pathological conditions of the 
system, may learn many valuable lessons thereby. 

And when to these lessons are added the knowledge to be 
derived from a chemical analysis of the urine in the different 
diseases also, and finally, that, from a microscopic examina- 
tion of the same, the precise nature of almost every malady 
may be determined with almost mathematical precision. 

Second— CHEMICALLY. Which is but the aid of chem- 
ical action of re-agents, and manual assistants, to the first. 

After the urine is fully surveyed and all its peculiarities as 
to color, consistence, etc., in the form as first discharged, is 
noticed, the changes which certain chemical agents may pro- 
duce thereon will sometimes establish certain other facts yet 



Urino-Pathology. 25 



unnoticed, or at least the more confirm what we have already 
learned. 

The character of these changes are, principally determined 
by their optical appearances also, to be noted, however, at the 
time. Upon the nice distinctions of color and other condi- 
tions, which the eye only can make, depends most of our 
positive knowledge of anything. And what more reliable 
sense is there belonging to man than the sense of sight ; yet 
it is here greatly aided by these chemical manipulations. 

The first chemical manipulation involves the determination 
of the acidity, alkalinity, or neutrality of the urine. This is 
done by immersing in the specimen to be tested, red and blue 
litmus paper alternately. If alkaline the red color of the pa- 
per will be changed to blue. If acid the blue color will be 
changed to red. And if no change in color occurs the urine 
is neutral. 

The following from the lectures of Dr. Aldridge is import- 
ant to be remembered: "If the urine be very acid in its 
reaction, and deposits a red, pink, buff-colored, or white pre- 
cipitate, the chances are that the precipitates are urates, or 
uric acid. If upon pouring out the urine the bottom of the 
vessel be stained with an even powdery coating, it is likely 
to be Uthates. If hard crystalline grains adhere to the sides 
and bottom of the vessel, uric acid. If either acid, alkaline, 
or neutral urine be turbid on emission, deposits a whitish, 
yellowish or red sediment and is not rendered transparent by 
heat, it contains either phosphates, oxalate of lime, cystine, 
mucus, pus, or blood. If phosphates, it will be rendered 
transparent by acetic acid. If cystine, it will be dissolved by 
water of ammonia. If oxalate of lime, it will not be affected 
by acetic acid nor aqua-ammonisc. If not dissolved by any 
of the above, it is mucus or pus, or if red it is blood.'' 

These constituents of urine are all easily detected by the 
several chemical testa that will be given in other parts of this 
work, and when the facts thus obtained, combined with mi- 



26 Urino-Pathology. 



croscopic revelations, all correspond in a given case, they 
will be a tolerably sure guide to correct conclusions. 

Third— MICROSCOPICALLY. Having examined a spec- 
imen of urine optically alone, then chemically in connection, it 
is ready for microscopic inspection. In fact the microscope 
might be constantly at hand during all the examinations, and 
should be applied to frequently in all the chemical changes. 
If by the microscopic examination of the merest fragment of 
a bone, a- naturalist is enabled to pronounce with certainty not 
only the natural family to which such fragment belongs, but 
to determine with equal certainty whether it was part of a 
thigh or a wing-bone of a bird, as also from microscopic exam- 
ination of the minutest fragment of the same bone is enabled 
to estimate the size of said bird, as was Prof. Owen, how 
much less difficult should it be for the medical practitioner to 
be enabled to ascertain by microscopic examination of any 
urinary deposit, not only the precise character of such deposit, 
but the nature of disease and the condition of the part whence 
such deposit is derived. 

"During the last few years," says Carpenter, "the micro- 
scope, in the hands of the physician, has become an indis- 
pensable auxiliary in the detection and diagnosis of disease." 
In many cases where long-known and well-attested methods of 
investigation have signally failed to detect the disease, the 
microscope has revealed important pathological truths. 

For the purpose of familiarizing objects to the view of the 
learner, that would be of benefit to him in examining under 
the microscope, urinary deposits, we have prepared the Chart, 
which exhibits the microscopic appearance of a great number 
of such deposits. For the same purpose we would recom- 
mend a "full set" of already prepared specimens, which are 
to be obtained in almost any city, by viewing which under 
the field of the microscope a few times, there will be no need 
of ever mistaking the kind of deposit, any specimen of urine 
may present. By such practice you will* also be much fa- 
cilitated in the use of the instrument; and you will only 



Urino-Pathology. 27 



have to let the urine repose a short time in a tall wine- 
glass, pour off the supernatant liquid, and place a drop of 
the under-stratum upon the glass-slide, when it is ready for 
inspection. Occasionally, however, it is necessary to resort 
to certain chemical re-agents, before the deposit can be sat- 
isfactorily ascertained. 

In the absence of prepared specimens of "urinary deposits," 
The Chart will be found a great auxiliary to the microscopic 
learner, in determining the kind or quality of matter he may 
have under investigation. 

The Chart should be spread to full view, in a place con- 
venient to the instrument. Place the glass-slide containing 
the deposit upon the stage, adjust the focus carefully, sur- 
vey the objects closely, then cast the eyes upon the Chart, 
and they will immediately catch the resembling cut or figure. 
A few alternate glances from the object to the Chart, and 
from the Chart to the object, will soon enable one to point 
out the complete resemblance. For it is a well-known fact, 
that even the most practical observer of anything, is not so 
apt to take note of objects or actions without his attention 
being directed to them, and hence the great value of " The 
Chart," in facilitating the progress of investigations. 



EXPLANATION OF CHART; 

AND 

INDICATIONS OF THE DEPOSITS REPRESENTED. 



FIG. I. — UREA. 

A. — Represents the residue of healthy urine after the water, 
about 956 parts in 1,000, is all evaporated. 

Healthy urine is of a light amber color, transparent, and 
of specific gravity about 1,020. 

B. — Oxalate of Urea, which, when in excess in urine, indi- 
cates plethoric disease, with dyspeptic tendency. 

C. — Nitrate of Urea, which, when in excess in urine, indi- 
cates derangement of the cutaneous function, with tendency 
toward both mental and bodily depression; and sometimes 
kidney affection. 

A deficiency of urea, indicates anemic, dropsical, and hep- 
atic diseases. 

The average proportion of nitrate of urea, in healthy urine, 
is 14.5 parts in 1,000, but in some diseases it exceeds 30 
parts in 1,000. 

FIG. II. — CHLORIDE OF SODIUM. 

A. — Represents crosslets and dagger-shaped crystals of the 
above salt, indicative of the presence of urea in excess ; and 
found by evaporating the urine quickly. 

B. — Chloride of Sodium, from water. It resembles oxa- 
late of lime, but is distinguishable from it by being soluble 
in water, which the oxalate of lime is not. 

C — Chloride of Sodium, from urine evaporated slowly. It 
resembles oxalate of lime, also ; but is soluble in water. 

D. — Chloride of Sodium, resembling cystine, but is more 
soluble. 

The average or standard proportion of chloride of sodium 
in healthy urine is 7 ^ parts in 1,000. 



Urino-Patliology. 29 



FIG. Ill AND IV. — URIC ACID. 

A. — Represents uric acid crystals from very acid urine, 
and indicates the highest inflammatory state of the human 
system, inflammatory fever, so called, inflammatory rheuma- 
tism, gout, etc. 

B. — Uric Acid, also, indicating a little less inflammation, 
with tendency to eruptive or cutaneous diseases, and found 
in measles, scarletina, etc. 

C. — Uric Acid, square form. Indicates more local inflam- 
matory action, with tendency to calculous affections. 

D. — Same as C, with tendency to kidney disease. 

U. — Same as C and D, with tendency to affections of the 
stomach, when mixed with oxalate of lime. 

The average proportion of uric acid in healthy urine is 
only * Q parts in 1,000 ; but in some diseases it exceeds two 
parts in 1,000. 

FIG. V. — URATE OF AMMONIA. 

A. — Represents the ordinary form of urate of ammonia, and 
indicates derangement of cutaneous functions, idiopathic fevers, 
(intermittent, remittent, etc.,) shingles, pemphigus, etc. 

B. — Less common form; indicates same diseases as A, 
only less violent. 

C. — Very rare form of urate of ammonia, indicates same 
diseases as above, with tendency to albuminaria, dropsy after 
scarletina, etc. 

D. — Urate of Soda, usual form in urine. Indicates the 
same disease as above, with greater tendency to local inflam- 
matory action, as in gout, scorbutus, etc. 

FIG. VI. — HIPPURIC ACID. 

This is not a normal ingredient of human urine, but is 
found therein after the administration of cinnamic or benzoic 
acid. 

The urine of horses and eat tie contain it in abundance. 

A, — Ordinary form, from human urine, when the above 
acids have been administered. 



30 Urino-Patholoyy. 



B. — Different forms, found under similar circumstances 
to A. 

(7. — Hippuric Acid, from alcoholic solution. 

D. — Same, from aqueous solution. 

E. — Crystals of hippuric acid, after the action of hydro- 
chloric acid on urine holding it in great excess. 

This ingredient is not indicative of disease, but a knowl- 
edge of it may serve to prevent imposition. 

FIG. VII. — PHOSPHATES. 

A. — Represents Triple Phosphates, (prismatic) and indicate 
irritable state of nervous system, mal-assimilation of food, 
mental debility, etc. 

B. — Triple Phosphates, (penniform) indicating the same as 
above, with tendency to disease of spinal marrow. 

0. — Same, (stellar and foliacious) indicating disease of spi- 
nal marrow, and if excessive, hypochondria, etc. 

D. — Mixed Phosphates, phosphate of lime, soda, magnesia, 
etc., indicates disease of brain and spinal marrow, with melan- 
choly, hypochondria, etc., and if mixed, as in ammoniaco- 
magnesian phosphates, is indicative of some cutaneous dis- 
eases, such as shingles, herpes, zoster, etc. 

FIG. — VIII. — OXALATE OF LIME. 

A, — Oxalate of Lime, octohedral, indicating derangement 
of digestive organs. 

B. — Same, when dry, indications same as above. 

C — Same, dodecahedral, indications same as above, with 
dyspepsia, inability of mental exertion, etc. 

D. — Oxalurate, dumb-bells, same as above, sometimes dis- 
ease of the bladder. 

E. — Oxalurate, oval form. 

These are essentially the indicative marks of dyspepsia, or 
derangement of digestive organs, and whenever found in the 
urine, in whatever form, all the varied symptoms of that 
many-headed monster may be confidently anticipated. (See 
Dyspepsia. ) 



Urino-Patholoyy. 31 



FIG. IX — CYSTINE. 

A. — Cystine , usual form, found in urine, and is indicative 
of scrofulous and cachectic disease, especially of the heredi- 
tary kind. (See Scrofula.) 

B. — Cystine, crystalized from ammoniacal solution. 

C — Vibriones, animalcule found in the urine of greatly 
debilitated persons of a cachectic habit, but more especially 
in that of those debilitated from syphilitic diseases. 

D. — Scaly Epithelium, from the vagina, indicative of leu- 
corrhoea, and irritation of vaginal mucus membrane. 

FIG. X. — ALBUMEN. 

Albumen is a coagulable lymph, and is one of the chief 
constituent principles of all the animal solids. 

In albuminous urine is generally found large quantities of 
epithelium, the cuticle of mucus surfaces. 

Dr. Gurnsey Smith says : " The peculiar appearance of 
the epithelial cells, will indicate the part of the genito-urin- 
ary mucus membrane from which the mucus was secreted." 

A. — Represents glandular epithelium from the convoluted 
portion of the tubuli uriniferi. 

B. — Pavement-like epithelium from the pelvis of the kid- 
ney. They are thin flat scales. 

C. — Epithelium from ureters, being columnar or cylin- 
drical. 

D. — Epithelium columnar also, from the fundus of bladder. 

E. C. F. — Epithelium from the trigone of the bladder, and 
from the bladder. 

Moulds of the uriniferous tubes are often found in the 
urine, and Dr. Smith says: "They furnish valuable aids in 
arriving at a correct diagnosis as to the pathological changes 
which may be going on in the kidney." They are most 
commonly found in the urine at critical periods of acute in- 
flammations, especially in scarlatina, small-pox, pneumonia, 
etc. These, however, are fibrinous easts, (see Consumption 
and Scarletina,) some contain oily granulations, which are 



32 Urino-Pathology. 



indicative of Bright' s disease, (see Glandular Kidney.) Al- 
bumen is not an ingredient of healthy urine, but an im- 
portant one of the blood ; and whenever found in the urine, 
is indicative of anemic diseases, consumption, dropsy, Bright's 
disease, and such as pathologically exhibit deficiency of albu- 
men in the blood. 

FIG. XI. — MUCUS. 

A small quantity of Mucus is generally found in urine, 
but it can scarcely be called an ingredient of healthy urine. 
When considerable, or in great excess, it indicates an irri- 
tation or inflammation of mucus membranes, especially of 
the bladder, urethra, vagina, etc., and contains epithelial cells. 

A. — Represents mucus, found in urine, and indicates cys- 
torrhoea, or inflammation of bladder. 

B. — Represents mucus acted upon by acetic acid. 

C. — Blood corpuscles, cohering. 

D. — Blood corpuscles, separate. These are sometimes in- 
dicative of leucorrhcea if a female, but more generally of 
gonorrhoea when found in mucus urine. 

IE. — Represents oil globules, more indicative of diseased 
kidney. 

F. — Represents epithelial cells, from the urethra, and is 
indicative of irritation of that part probably from gonorrhoea. 
Gonorrhceal mucus, abounds more in pus cells, than the 
leucorrhceal. 

FIG. XII. — DIABETIC SUGAR. 

A. — Represents Toruloe Cervisce, which is only found in 
saccharine urine after it has undergone saccharine fermen- 
tation. Indicates diabetes, or disease in which sugar is found. 
(See Toruhe. ) 

B. — Represents a fungus growth in acid urine which con- 
tains albumen. Indicates weakness, lassitude, emaciation, 
and sometimes phthisis. 

Q. — Spermatazoa. Indicating seminal disease, nocturnal 
emissions, etc. 



Urino- Pathology. 33 



D. — Peniculum Grlaucum, different form from B, the urine 
being acid and containing albumen also. Indicates a weak- 
ness of nervous system and general debility, Diabetis mel- 
litis, etc. 

FIG. XIII. — PUS. 

A. — Represents Pus Gflobules as they appear in urine, and 
are indicative of suppurative inflammation, purulent absorp- 
tion, or abscess of some part of the system. 

B. — Pus globules acted upon by acetic acid. 

C. — Large organic globules. 

D. — Small organic globules. 

JEJ. — Coagulated albumen as found in Bright's disease, also 
in dropsy, etc. 

The contents of abscesses of liver, spleen, and different other 
organs, have been known to escape into the kidneys and be 
discharged with the urine. 

FIG. XIV. — LEUCORRHCEAL MATTER. 

This figure represents the appearance of matters contained 
in the leucorrhoeal discharges, and are a mixture of mucus, 
pus, blood, and epithelium, from the vagina. 

Leucorrhoea is a disease of frequent occurrence, and the 
matter thereof may be detected in the urine of those labor- 
ing under that affection by their microscopical appearance, 
as here represented. Vaginal epithelium is always of the 
scaly variety. Leucorrhoeal matter is to be determined from 
gonorrhoeal, by the latter containing a greater number of 
pus cells. The increase of the cell elements and the dimi- 
nution of the viscid matter, are indications of more virulent 
disease. 

FIG. XV. — PUS, FAT, AND CANCER-CELLS. 

A. — Represents Purulent matter from scrofulous disease, 
and when connected with Cystine, may be referred to scro- 
fula of the hereditary kind. 

B. — Represents Fat globules sometimes found in urine ; 
they are usually fat cells filled with oil, and resemble those 



34 Urino-Pathology. 



produced by mixing oil with water by the aid of mucilage. 
It appears to indicate a tendency to remarkable obesity; and 
is found only in the urine of persons of fatty degeneration 
of some or all of the parts. 

C. — Represents Uterine Cancer- Cells found in the urine of 
females laboring under cancer of uterus or womb. " In 
cancer of the uterus," says Smith, "the microscopic examina- 
tion of the discharges becomes highly important in arriving at 
an accurate diagnosis." " Cancer cells in such cases may often 
be detected in the discharges." The student should be care- 
ful, however, not to compound the columnar epithelium of 
the ureter, with the spindle-shaped cancer cells which they 
somewhat resemble. 

FIG. XVI. — CANCER-CELLS. 

A. — Represents the caudated cells which are of common 
occurrence in cancer tumors ; and in cancer of the bladder 
are invariably present in the urine. 

To know this, is of much importance, as there are noo ther 
means whereby the fact of such cancer of bladder, can be 
correctly established but by microscopic examination. 

B. — Represents the concentric cell, as seen in cancer of 
the breast and ovaries. 

The profession are nearly all now ready to acknowledge 
the necessity of a microscopic examination of those matters, 
to a correct diagnosis, and proper discrimination between 
pus, mucus and cancer-cells. "By the use of the micro- 
scope," says Carpenter, "the medical practitioner who is 
familiar with the aspect of urinary deposits, may determine 
on the spot, the nature of any sediment whose character he 
may wish to know." 



Ih 



Containing- a Microscopical Appearance of oveii 



Sixty different Ingr. 



idients found in the Urine. 




Evaporated KcMdne „i' ITotiltliy Urine.- 





URATE OF AMMONIA. 


V 


figs. 


1 


i 






^3 




A. — Urate of Ammonia, ordinary form 




B. — do. do. less common. 


1 


C. — do. do. rare form. 




D. — Urate of Soda, usual form in Uvii 
J?.— Urate of Soda, rave form in Urin 




i aic void, 



ly from Urine. 

D.— Chloride of Sodmi 

sembles Cystine. 



j 1 r I ' I ' r - 1 ; r < ■ mil. 



' 



'- 



1% 







.1.— Uric Acid, from Urine. Very Acid. 
B.— Uric Aeid. Rhomboidal form. 

D.— do. Kara form. 

.£■.— do. Mixed with other Urates. 



I'lIOSVJIATKS. 



im^To 










-llippuric Acid from Alcoholic solutio 

- do. do. from Aqueous solutio 

— do. do. from urine after actii 

of hydrochloric acid. 






1-1,1 III 

1 .. 






■■»; 



o 



Wit 



%8% 



ITS ^LgBULES. 



■ 






m 



A. — Triple Phosphates, prism. 

B. — do. do. penniform. 

0.— do. do. stellar and folia 

V. — Mixed Phosphates. 



m ncuf 



I).— do from fundus 
J!.— Cells and nucleus fro 

bladder. 
F.— Epithelium from bladde 



©© 
"1?. 



'.— do. acted upon by i 

'.—Large < Irgamc Globules, 
D.— Small do. do. 

I'. -' , . l ;,! : ;ii|.il,',l AtllllltH'il. 



<M 



Mucut pus, bl I and epithelium from Lu- 

'""■'1 ■ The paginal epithelium in 

the urine is always of the reals m- 





*^o* 



^8 






-t. — Oxalate of Lime, octoliedral. 
B.— do. do. when dry. 

C'. — do. do. dodecnhudr.il. 

D— Oxalurate Dumbbells. 
E. — do. do. oval form 





; 


. . 


' . 




idate Cancer Cells Bn 
-Concentric Cells, from 



GENERAL PRINCIPLES 



There must be first principles in medicine as well as in 
philosophy. Without a basis to stand upon ; a standard from 
which to calculate ; a starting-point as it were, the princi- 
ples and practice of medicine, in fact the principles of any 
art or science can not be satisfactorily elucidated, intelligibly 
explained, or properly understood. 

There must be a starting-point for every thing — a zero as 
it were from which to measure the degrees in excess or defect, 
or the kind of perversion that may exist. 

Anatomy is the basis, the ground and pillar, the super- 
structure, the whole frame-work, upon which all rational 
medicine is built. It furnishes us with the " standard" of 
structural health ; any irregularities or deviations from which, 
is structural disease. 

Physiology gives us an account of the action of the organs 
and parts which anatomy only describes. The clue and pro- 
portionate performance of these actions constitutes the con- 
dition and "standard" of functional health; any disturbance 
or irregularity in the performance of which, is functional dis- 
ease. 

A normal condition of a structural part is the standard from 
which any irregularity of structure is to be computed ; the 
normal operation of any function, the standard of health of 
that function. Any excess or defect of structure or of func- 
tion, is to be counted in degree or hind from these stand- 
ards of normality. 

Disease is defined by Williams to be M a changed condition, 
or proportion, of function or structur<\ in one or more parts 
of the body." 

Pathology is only a description of these change? — a de- 
scription of tho irreguhritiei of anatomy and physiology, 



36 Urino-Pathology. 



their causes, nature, and symptoms. " The investigation of 
these phenomena, and their reduction to general laws expres- 
sive of their conditions, is the object of pathology." 

The causes of disease are divided into intrinsic and extrin- 
sic ; or those having their origin within, and without the 
body. Also into predisposing and exciting causes — of those 
which fall a little short of actual disease; and those which 
actually produce disease. The causes of disease are also 
divided into cognizable and non-cognizable; or those which 
we know by our senses, and those which we can only infer 
their existence by their morbific effects. 

The difference between a sign, and a symptom of disease, 
lies in this — that a sign is that by which a disease is made 
known — a symptom being only the phenomenon which becomes 
obvious in the course of a disease. The one is perceptible 
to the senses-^- the other is dependent on physical properties. 

The vis medicatrix naturce is that power which unites frac- 
tured bones, and heals wounded parts — that resists injuries, 
as well as repairs them. 

Predisposing causes of disease are very numerous, compris- 
ing a long catalogue; and of all these, debilitating causes of 
predisposition to disease are the most numerous. 

Previous disease — hereditary disposition, temperament, occu- 
pation, and the influence which age exerts in predisposing to 
disease — the several changes from early infancy to childhood, 
to puberty, to termination of growth, to adult and old age. 

The predispositions of each of these, and their several patho- 
logical conditions, ought to be viewed. These being among the 
primary elements of disease, they contain many of the first 
principles of pathology. 

Among the exciting causes of disease, are mechanical, chem- 
ical, non-alimentary metals, poisons, etc., togther with excess 
or defect of the alimentary. 

The chief alimentary matters are the albuminous, gelat- 
inous, oleaginous, and saccharine. Albuminous supplies the 
the albumen and fibrin of the blood ; the gelatinous only sup- 



Urino-Pathology. 37 

ports it ; oleaginous supplies the fat, textures, and secretions, 
and furnishes fuel for the maintenance of animal heat; sac- 
charine supplies the material for the process of respiration. 

These processes ought all to be examined in detail, and their 
standard qualities and pathological conditions studied ; also the 
effects of heat and of cold upon the system, their patholog- 
ical action, and the pathological conditions they produce — 
congestions, determinations of blood, and inflammations of 
organs, which are the results. 

Endemic, epidemic and infectious causes of disease, are 
among the wcm-cognizable. Ague is endemic ; cholera, epi- 
demic ; and small-pox infectious. 

The causes, nature, and pathological conditions of these are 
interesting, indeed. They are all to be regarded as a blood 
poison, specific and different in effects. 

Infection may be obtained by contact, through wounds, by 
exhalations from the body or breath, or by the air, through 
the lungs. 

Infection is generally destroyed by heat, of one hundred 
and twenty degrees Fahrenheit, while cold also injures its 
vitality. Warmth, closeness and filth, increase its virulence. 

Thus far we have only been viewing some of the causes 
of disease, or the elementary principles which enter into the 
formation of disease, or predispose to that result. This is 
necessary to the more ready arrival at the nature of disease. 
We will next inquire into the elements of disease itself. 

Disease proper "is a changed condition from the natural 
structure or function of the body." There are primary ele- 
ments — healthy and diseased — of structure and of function ; 
and secondary elements of disease, composed of the primary 
in some combination. 

The varieties of disease are comprehended in degree and 
kind. Degree includes excess and defect Kind relates to 
perversion. 

The property of contractility oi' muscular fibre may bo- 
come excessive from over-feed of blood, and produce spasms, 



38 Urino-Pathology. 



cramp, or tetanus. Defective contractility, by a -want of due 
supply of blood to the muscular part, may result in paral- 
ysis, local or general, etc. 

Tonicity differs from irritability in this, that its tendency 
is to slow and moderate contraction. " Its tendency is to 
keep muscles in their places when at rest, and out of their 
places when distended." Irritability and tonicity are the 
"standards" of functional health of muscles. Excess or defect 
of these, their pathological or diseased conditions. The same 
in the nervous structure. Insensibility, voluntary motion, 
reflex action and sympathy, are " standards" of healthy pro- 
perties of this structure. 

Excess, defect, or perversion of any of these properties, is 
disease — and hence, pathological. The pathological cause of 
excessive general sensibility, is an undue supply of blood to 
the parts of the cerebral mass concerned in sensation. That 
of defective general sensibility, is in the impeded circulation 
in the sensitive center of the nervous system. The patho- 
ical cause of perverted sensibility must be sought for in the 
irregular supply, or bad quality of blood, which supports the 
nervous system. And so, in voluntary motion, reflex action 
and sympathy, all may be excessive, defective or perverted, ac- 
cording to degree or kind of pathological condition of the blood, 
and its circulation to or through the parts concerned in the 
disordered action. In all disorders of vital properties, these 
pathological conditions are plainly referrible to the changes 
in supply or quality of the blood to their textures, or parts 
concerned. The same is the case in diseases of secretion; 
and, like other functional properties, these may be excessive, 
defective or perverted, also. Each secretion has its own 
peculiar effects connected with its office ; and these effects 
may be forwards on the parts to which the secretion goes, 
or backwards on the organ which secretes it. 

But there is, besides excess and defect of secretion, a per- 
version of secretion. The normal action of secreting organs 
is the " standard," and these deviations constitute the diseases 



Urino-Paihology. 39 



in degree and kind. Perversion is a deviation in kind. It 
is a morbid change in the secretion itself, as when the urine 
takes on qualities not belonging to it, etc. Perverted secre- 
tion may not only be caused by a deranged condition of 
the blood, or of its circulation, but it may have deleterious 
effects upon that fluid itself, and thereby become the source 
of different diseases, according to the parts engaged, and the 
kind of perversion. 

And thus it is, that whatever property is exemplified, 
whether of irritability or tonicity of the muscular fibre — of 
sensibility, voluntary motion, reflex action, or sympathy of 
the nervous system, or of disease of secretions — the normal 
action of each is the "standard" from which to calculate the 
excess or defect in degree, or perversion in kind. 

In whatever way these deviations from the normal stand- 
ard may exist, and whatever effects they may produce, the 
blood will be found to play an important part in every patho- 
logical condition and action in the living body. 

In fact, when we come to view the whole make-up of the 
human body, from the embryo to the full-grown man — and 
to consider that from the blood the form begins, the nour- 
ishment is given, and the growth is completed ; as also from 
or by the same source injuries are repaired, and disease is 
removed ; and that when the blood fails to carry on the pro- 
cess of life in any part, disease begins ; and if not interrupted 
or overcome by the vital powers of that blood, death ensues ; 
and that when death ensues the blood solidifies in part, and 
can not by any known process be reproduced out of the 
body, no more can the functions or properties of functions 
be carried on without this blood, we must conclude, with a 
writer of old, that "the blood is the life." 

But let us examine still farther the secretions and excre- 
tions, and their effects upon the blood and upon the system. 

Pathologists tell us that excessive secretions, if abounding 
in animal matter, may not only reduce the mass of blood, but 
also affect its composition. 



40 Urino-Pathology. 



If the urine be separated in unusual proportions from the 
blood, it must leave that blood modified. 

Urine contains a preponderance of azote, and its excessive 
formation from the principals of the blood, would leave a pre- 
dominance of hydrogen and carbon in this fluid. 

But it might be said that the urine is not formed from the 
constant elements of the blood alone, but from the materials 
derived from food and from the decay and transformation of 
the tissues; whether, from the blood itself, or the co-opera- 
ation of all these processes, a uniformity in the composi- 
tion of this circulating fluid must be maintained, and if one 
of these processes is more active than the others, the blood 
must suffer by the excess of matters which the less active pro- 
cesses allow to accumulate in it. Williams sums up thus : 
"A flux of bile is either accompanied by a highly-loaded 
state of the urine, or by fever ; in the latter case, the fever 
does not subside until the urine becomes very copious, or 
deposits an abundant sediment. The interpretation of this 
fact is : that the excessive secretion of bile disorders the com- 
position of the blood. So long as the kidneys rectify this 
disorder, by separating in greater abundance the solid con- 
tents of the urine, no fever results ; but if the kidneys fail 
in this task, fever ensues, and continues until they accomplish 
it; then a free secretion and copious deposit, are symptom- 
atic of the decline of the fever." 

But secretions may sometimes become defective, in conse- 
quence of a weakened state of the whole circulation, or of 
the secreting organ itself, or in a variety of ways. 

" The distinctive materials of the urinary secretion appear 
to be positively noxious, and poisons the system if not sep- 
arated from the blood. Thus — the sudden suppression of urine 
sometimes causes typhoid symptoms ; and the amount of dan- 
ger depends on the extent and suddenness of the diminution 
of the excretion." 

In these cases, urea is found in the blood. The positively 
noxious property thus retained in the blood by suppressed 



Urino-Pathology. 41 



urinary secretion, should always be taken into account when 
we are considering the conditions and treatment of idiopathic 
and symptomatic fevers, the constitutional effects of which 
are no doubt measurably due to this element. 

" The changes in the blood, manifested in some such cases 
by its fluidity and by petechial appearances, may also be 
referred in part to defective elimination of effete matter thus 
retained, for it is when the secreting organs recover their 
power, and a copious discharge of highly-loaded urine occurs, 
that these appearances cease." 

But there is perversion of secretion, and this often accom- 
panies excess and defect of this process. 

In febrile diseases the secretions from the kidneys especi- 
ally, are prone to alterations exhibiting remarkable changes in 
quality, sometimes causing disorder even in their own organs, 
all of which will be referrible to changes in the blood itself, 
or in the supply of blood to their textures. 

In examining the constituents of the blood and the changed 
condition in different diseases, it might be well to take a glance 
at the properties of the blood itself — for without a " stand- 
ard" of properties as well as a "standard" of constituents, 
we can not measure these deviations, nor determine the ex- 
tent of alterations. 

This circulating fluid consists of red particles, called red 
globules, fibrin, or colorless globules, and liquor sanguinis. 
But for the better measurement of disease, as above stated, 
the " average natural proportions of these chief constituents of 
blood, in health," are given as a "standard," in a subsequent 
part of this work, any very considerable deviation from which 
proportion of constituents, is considered as disease. 

Each of these parts having properties peculiar to them- 
selves ; although they may approximate their proportion, thov 
may be defective in property. 

"The red-blood disks seem to bo the part of the blood on 
wMcn its vivifying properties chiefly depend," and it is said 
that the vigor and beauty of the corporal frame is dependent 



42 Urino-PatTiology. 



more upon these red particles in the blood, than to any 
other constituent. 

The obvious sign of this state of the blood is the florid 
color apparent in the lips, cheeks, gums, and other vascular 
parts of the body. 

These red particles are defective in all anemic states of 
the blood, and all cachectic, scrofulous and tuberculous dis- 
eases, chlorosis, etc. The signs of this defect are, paleness 
of the parts naturally colored with blood. 

Besides the excess and defect of these red particles, there 
may be alterations in these particles, as is evidenced in the 
readiness with which textures become stained in some diseases, 
as in petechia, etc., and also altered in form and size, and 
other properties. 

Fibrin. — This appears to be the constituent which causes 
the coagulation of the blood, and the part which constitutes 
the buffy coat, and is considered to be the material by which 
textures are chiefly nourished and repaired. Its changes, 
therefore, must constitute an important element in disease. 
It exists in larger proportion and higher perfection, in arte- 
rial than in venous blood. It consists of congeries of fine 
fibres, with transparent bodies or globules scattered through 
them. In fluid blood we see the same pale corpuscles, but 
none of the fibres. The formation of these fibres is what dis- 
tinguishes it from albumen. It has the peculiar property of 
solidifying in a granular mass, and this capacity is considered 
to be an attribute of inherent life — or closely connected with 
vital activity in the sanguiferous functions. 

Its fibres, cells and granules, may be regarded as the rudi- 
ments of new living textures, and that it maintains the con- 
ditions of a most highly animalized material, which renders 
it fit for the peculiar properties of life. 

The coagulation of fibrin is promoted by the contact of a 
rough solid ; thus, by stirring fresh-drawn blood with a stick, 
the fibrin adheres in shreds to the stick. 

The same property is exhibited within the body in the 



Urine-Pathology. 43 



deposition of lymph on the rough surfaces within the great 
vessels. The same cohesive property of fibrin causes it to 
aggregate in patches and films on the surface of membranes, 
and these form the basis of the construction or reparative 
process. 

This coagulable lymph is carried to any and every part of 
the body, even into the minutest of structures, and there 
deposited freely when needed in any cases of lesion or solu- 
tion of continuity of a part. 

Deficiency of fibrin is of frequent occurrence in many dis- 
eases. In these cases there is a tendency to hemorrhages, 
to unmanageable oozing of blood from slight wounds or 
breaches of texture, and these are very difficult to heal, as 
also are fractures to unite, for want of the material for their 
nourishment and growth. 

Albumen of the Blood. — It is this principle chiefly that 
gives the blood-liquor its thickness, and which renders it the 
more fit to pass along the vessels, preventing it from passing 
through their walls. 

The deficiency of albumen in the blood is most remarka- 
bly met with in many diseases. This deficiency of albumen 
seems to be a chief constituent in dropsical diseases, and it 
is thought that all the cases of anemia, which are attended by 
dropsy, owe this concomitant, to a defect of albumen in the 
blood. 

In cases of albuminaria, or disease of kidney, with coag- 
ulable urine, there is most remarkable deficiency of albumen 
in the blood, it being constantly carried off in the urine. 

While we regard fibrin as the real vital or life-giving prin- 
ciple of the blood, and the nutritive and formative matter of 
the body, we know that there are those who incline to a dif- 
ferent view, thinking, as Simon says, that they have cogent 
reasons, for placing it on the same scale as the extractive 
matters, and recurring among those elements which have arisen 
in the blood from their own decay, or have reverted to it from 
the waste of tissues. This view is taken of it by Dr. 



44 Urino-Patholoyy. 



Zimmerman, also. The cases which they produce, however, for 
proof of this position, appear to us, not to be well selected. 
In " the fact of fibrin being not only undiminished but usu- 
ally increased in cases of repeated bleedings," may not this 
augmentation of vitality,or superfibrination of the blood, be a 
wise provision of nature to supply the waste in the body, 
occasioned by such loss of blood, and which remains unappro- 
priated for want of this fluid to carry it thither ? 

And, in the fact of " the fibrin of the blood being proportion- 
ately increased during the progress of starvation," may not this 
state, also, be accounted for in the same way, or because of 
its non-assimilation, or non-appropriation to the parts requir- 
ing it? 

And conversely, as regards the fact that " there is little or 
no fibrin in the blood of the foetus," may not its excessive 
assimilation and appropriation necessary to that quick devel- 
opment, and rapid growth in the foetus, keep the blood nearly 
exhausted of this life-giving principle ? 

In utero-gestation, there is relatively a more rapid forma- 
tion or growth of the living body, by several hundred per cent., 
perhaps, than is ever accomplished in after life. 

Now, as " these facts, derived from very different sources, ap- 
pearing quite mexplicable on the theory that fibrin is essential 
to the progressive development of tissues, and must be consid- 
ered an excrementitious product, derived from the waste of tis- 
sue," we think there is nothing plainer than the opposite, and 
that these facts bear the proof in themselves, and are much 
more probable than the "explosive theory," as represented by 
some pathologists. 

Fat. — The fatty matter of the blood is sometimes so very 
much increased beyond the normal standard as to give a 
milky appearance to the serum. The increase of fat in the 
textures is no doubt in some way connected with its excess 
in the blood. Exercise tends especially to reduce the fat of 
the body ; while indolence, full living and good digestion, tend 
to increase it, and even to produce obesity. Unhealthy fat, 



Unno-Pathology. 45 



however, commonly increases at the expense of strength, and 
is reduced in proportion as muscular power and activity is 
restored. 

Saline Matter. — The saline matter dissolved in the blood, 
tends, according to experiments, to preserve the form of the 
red particles, and the fluidity of the fibrin. " There can be 
little doubt," says Williams, "that the thirst induced by salt 
food, is connected with an excess of saline matter in the 
blood, which causes a shrinking in size of the red corpuscles, 
and wherever they circulate, they attract by endosmose fluid 
from the textures and surfaces ; thereby exciting that demand 
for liquid which the feeling of thirst is intended to supply." 

Diminution of saline matters in the blood may cause it to 
coagulate in the vessels, and the red particles to become dis- 
solved and altered. This appears to be the case in yellow 
fever, as reported by Dr. Stevens, and it seems that a defect 
of saline matter in the blood in cholera, has something to do 
in producing the lividity and collapse which characterizes 
that terrible disease. 

Water in the Blood. — The proportion of water in the 
blood generally increases as that of the animal contents in 
the blood decreases. In all anemic diseases the blood is more 
watery than usual, as also after extensive hemorrhages or re- 
peated venesections. The effect of this state of the blood is 
to cause a tendency to dropsical effusions, while a deficiency 
of water in the blood is exemplified in many diseases; in so 
extraordinary a degree in malignant cholera, that it can not 
circulate freely in the vessels, and hence this deficiency is the 
chief cause of the cessation of the pulse. 

The Changes in the Blood. The first anfl most important 
change in the blood is produced by respiration — the process 
by which venous blood is made arterial and fitted for main- 
taining life. 

According to Williams, this process comprises the absorption 
of oxygen, the removal of some carbonic aoid and water, a 
slight increase of fibrin, etc. The absorbed oxygen, by its 



46 Urino-Pathology. 



affinity for the hydrogen and carbon of the blood, perhaps, 
evolves heat, the renewal of fibrin supplies the expenditure of 
the plasma ; while the removal of the carbonic acid is probably 
an excretion of noxious matter. 

It is thought by some that this change in the blood from 
venous to arterial, is never carried on to excess; that the activ- 
ity of respiration is always proportioned to the rapidity of the 
circulation, and the corresponding need of change in the blood. 
But in acute rheumatism there is great increase of fibrin in the 
blood, whether there be increased rapidity or not ; hence the 
probability is that this change or conversion of venous into 
arterial blood, is sometimes carried on in excess. Defect of 
this change in the blood by respiration, is a very common ele- 
ment of disease, especially in affections of its respiratory ap- 
paratus ; the phenomena of which is compounded by authors 
as follows : " 1st, Accumulation of blood in the venous sys- 
tem ; 2d, Diminution of blood in the arterial system ; 3d, 
Deficiency of oxygen and excess of carbonic acid in the blood." 
There is, in these cases, not only a want of due supply of blood, 
but it is bad in quality, also. If, when the respiratory changes 
are defective, there is scarcity of fibrin in the blood — when we 
find the fibrinous element in excess in this blood, it seems highly 
probable that there is excessive respiratory changes in the blood, 
also. 

Bile. The defective secretion of bile is often obvious in the 
yellow color of the serum and fibrin of the blood, and is con- 
nected with structural disease of the liver, or an imperfect ac- 
tion of that organ. It produces a general impoverished condi- 
tion of the blood, with general cachectic state of the system. 

Perspiration. " The perspiratory secretion contains lactic 
acid, and lactate of soda and ammonia, which it is believed pro- 
ceeds, in part, at least, from the transformation or decay of the 
textures, particularly the muscles, which contain a preponder- 
ance of this acid. Hence, when this secretion is checked, 
these products may be retained in the blood and cause urinary 
disorders or cutaneous affections — thus, when the skin fails to 



Urino-Patliology. 47 



secrete, an increased task is thrown upon the kidneys ; if these 
organs fail in their task the lactie acid accumulates in the 
blood, and may produce either urinary or cutaneous affections 
according to the predisposition of the patient. If there ap- 
pears a copious deposit of this morbid matter in the urine the 
system may be relieved without much disturbance in the animal 
economy. The character and quality of the urine is a pretty 
sure criterion as to the affection produced, however ; whether it 
terminates in inflammatory action of the urinary apparatus, or 
determination to the cutaneous surface, or, as is sometimes the 
case, an accumulation of the morbid matter deposited in the 
joints. 

" In Saccharine Diabetes, the morbid matter is of a nature 
quite contrasted with that of gout or rheumatism, and the 
effect which each exerts is quite different. While the lithic 
acid in the latter disease has a tendency to accumulate in the 
body and to cause local irritations ; the sugar, in the former, 
has no such accumulative tendency, but acts rather as a diuretic, 
passing rapidly away, carrying with it large quantities of 
water and the other constituents of ordinary urine." " The 
appearance of sugar in the urine," says Williams, "can not be 
considered otherwise than as a result of its presence in the 
blood, and is formed from starch and gum under the action of 
acids." How very readily may be detected these conditions 
of the system, by an analysis of the urine, where the patient 
has not been visited, these different diseases can be as read- 
ily distinguished by the different qualities of that fluid, or 
more readily than by all the other signs. In.fact, it gives us 
the only positive declaration that can be made, and the only cor- 
rect solution of these cases is made by an examination of the 
urine. 

But the blood is changed in properties from the presence 
of foreign matters, such as poisons, exerementitious matters 
retained, etc. Some poisons act upon the body much quicker 
than others, and they all act much quicker upon an empty 
than a full stomach, as also poisons act much quicker in 



48 Urino-Patliology. 



solution than -when in a solid state. Any condition that 
favors quick absorption, favors the quick action of the poison 
upon the system. The most remarkably quick effects of poi- 
son are produced by prussic acid. It is said to produce its 
symptoms even in the act of sm allowing it ; and seldom are 
they delayed beyond one or two minutes." 

How its effects can be produced upon the blood before 
the poison has reached the stomach, is explained by the 
fact, that the most ready contact with the blood in general 
circulation, is through the medium of the lungs; and that 
this substance is capable of producing, by fumigation, the 
most sudden effects. Its mode of introduction into the blood 
is most direct, and its effects as immediate. This poison 
has been detected in the urine in one minute after its intro- 
duction into the blood. Pus has been frequently detected 
in the blood by the aid of the microscope. The germs 
of many diseases are no doubt spread through the system 
through the medium of the blood by inhalation, by absorp- 
tion, and by retained excretions. 

The first object of the practitioner, in all such cases, should 
be to counteract the injurious operation of these matters ; the 
second, to expel them from the system. How are we to know 
the antidotes to these, without knowing the kind of poison ? 
By an examination of the urine we will be enabled to determine 
this point, or at least we will be much aided in our judgment in 
the case. But we do not always possess chemical antidotes, 
and especially those which can act on the foreign matter when 
in the blood, without injuring the blood itself; then our next 
object should be their expulsion from the system. 

Here the excretory organs, especially the kidneys, must be 
called upon for the full performance of their functions. " Be- 
ing the natural emunctories through which foreign and offending 
matters are expelled from the blood, diuretic medicines will be 
found of utility here." 

" Orfila found that the pernicious effects of small repeated 
doses of arsenic even, might be averted, by giving at the same 



Urino-Pathology. 49 



time a diuretic medicine." Now we are fully satisfied that what- 
ever poison be administered, or in what other way it may enter 
the system, and in whatever time it may take the same to act 
on the living body ; whether in three seconds, as in some cases, 
or tnree days, or three weeks, as in others, the action of the 
poison is upon the blood, and the effects produced are through 
that medium. 

Even where there is no perceptible interval of time between 
the contact of the poison and the production of its effects ; and 
where there was scarcely an appreciable amount of the poison, 
the action is upon the blood, whether by shock, as an electric, 
thence upon the nerves, it matters not, the impression is made 
through this fluid. And when we see, not only these poisons 
themselves carried off in the urine, and find that the serious 
effects are thereby reduced, we can not but conclude, that the 
urine gives the most unerring evidence of the true nature of 
the case at the time. 

Hyperemia. — The morbid conditions connected with excess 
and defect of blood in the vessels, have been somewhat 
noticed. The blood-making process is said to be ever on 
the increase in those whose digestive powers are in full ac- 
tivity, especially if these be indulged without exercise of the 
body. It may be in excess from too much blood being made, 
or from too little being expended. If, in either case, the 
great secreting organs fail in their proper function, disease 
is the immediate consequence. 

Plethora may be sthenic or asthenic, or plethora with or 
without strength. Sthenic plethora comprehends a rich state 
of the blood and an active condition of the nutritive func- 
tion, and has a tendency to cause general inflammatory ex- 
citement. In asthenic plethora, there is want of strength, of 
vigor and of action, notwithstanding the augmented quantity 
of blood in the vessels. It generally affects those weakened 
with age, excesses, or previous disease, and those in whom 
the excreting functions are imperfectly per formed. 



50 Urino-Pathology. 



Anemia. — This term is applied to that condition of the sys- 
tem in which the predominant character is a deficiency of 
blood, together with a deterioration of its quality. Anything 
which withdraws or injures the blood, and especially the red 
particles, or anything which interferes with the formation of 
blood, tends to produce anemia. 

This consideration of the system may be either general or 
partial ; general, when the whole body is aifected, and a gen- 
eral failure of the vital powers takes place ; partial, when the 
defect of blood is more confined to a part of the system. 
Thus, whatever diminishes the supply of blood in a part, im- 
pairs the functions of that part, and anemia of the part is 
the result. Even a deficient supply of blood to the secreting 
organs themselves necessarily impairs their action, and soften- 
ing and wasting of these organs is the consequence. 

These conditions may be determined, in some measure, at 
least, by the character of the urine passed at the time. 

Congestion. — Congestion may arise from an obstruction in 
the veins, which prevents a free escape of blood from them ; 
or it may arise from atony or want of tone in the blood ves- 
sels themselves. It comprehends an excess of blood in a part, 
with motion of that blood diminished. If the veins be ob- 
structed by a ligature, an excess of blood is retained in the 
part, because of the diminished motion of the blood, from the 
obstruction ; and so anything which obstructs the blood in the 
veins leading from an organ, may produce congestion of that 
organ. Or anything which impairs the elasticity or tone of 
the blood-vessels themselves, or that may so enfeeble the ac- 
tion of the heart as to prevent the full circulation of blood 
through the whole circuit, by gravitation of the blood in the 
most depending parts, may cause congestions in parts that 
are lowest in position in the body. In proportion as the 
blood accumulates in one part of the body, it leaves the rest 
with less than its proper share, and hence weakness of these 
parts may ensue. 



Urino-Pathology. 51 



The stagnant blood of congestion not only becomes unfit 
for use in the animal economy, but it becomes a source of 
contamination to the rest of the blood, and causes cachexia 
of the blood at large when these contaminated matters are 
not promptly removed by the excretory organs. 

Determination. — Determination of blood is different from 
congestion in this, that while there is excess of blood in a 
part, in both, in congestion the motion of that blood is di- 
minished, in determination, the motion of blood is increased. 

In this condition there is generally an enlargement of the 
arteries as well as the veins, and the whole vascular plexus 
becomes the channel of a much-increased current both in ac- 
tivity and in volume. There is a stronger pulsation of the 
arteries leading to the part, and an increased quantity of 
blood in the part. 

Determination of blood to any part, in a moderate degree, 
generally increases the natural secretions of the part. Thus, 
a determination to the kidneys may cause an increased flow 
of urine, and the urine itself may not only exhibit an in- 
crease of its water, but also of its acid matter, with more or 
less of the epithelial cells of the uriniferous tubes. 

This result, occurring in the secreting organs or open sur- 
faces, constitutes what is called fluxes, even "urinary flux." If 
it occurs in closed sacs or cellular textures, however, it consti- 
tutes dropsies. As flux and dropsy, then, may arise from a simi- 
lar condition of the vascular system, they may be found to suc- 
ceed to one another. The occurrence of dropsy is generally 
attended by a marked dininution of the urinary secretion, and 
a free flow of this often reduces dropsy. The occurrence of 
diarrhoea is also* attended with a diminution of the urinary 
secretion, and a free flow of urine is a good indication oi' con- 
valescence. In cholera, there is generally almost entire suspen- 
sion of the urinary secretion, and among the first indications 
of convalescence is a free flow of urine. 

When the vital powers of the kidneys have become reduced 
and unable to perform their vicarious action, in cases of excess 



52 Urino-Patholoyy. 



of blood thrown upon internal organs; instead of separating 
the proper constituents of urine in sufficient quantities, the 
superfluous water accumulates in the blood, and by the quan- 
tity as well as quality, favors the effusion of serum. And 
when, in connection with this condition, there is loss of albu- 
men from the blood, this loss still the more thins the blood, 
and thus facilitates the dropsical effusions. In these cases 
the albumen of the blood will be found passing off in the 
urine ; the water of the blood, which should pass off as urine? 
is found in the cavities or tissues ; and the salts which are 
wanting in the urine, are found in the dropsical fluid. This 
is the pathology of dropsy in a nut-shell. 

Inflammation — In inflammation we have excess of blood in 
a part, the same as in congestion and determination, and 
like in determination, there is also a stronger pulsation of 
arteries leading to the inflamed part, but the motion of that 
blood is opposed by obstructions, and there is consequent 
stagnation of blood in the part. The difference between con- 
gestion, determination and inflammation, may be summed up 
thus : In congestion the capillaries are enlarged without any 
increase of the arteries. In determination the arteries and 
capillaries are both enlarged, and in due proportion. 

In inflammation the arteries and capillaries are both en- 
larged, but the blood particles adhere to each other and to 
the walls of the vessels, and thus become more or less stag- 
nant, until the obstruction is confirmed. Inflammation con- 
sists then in the increased motion of blood to the affected 
part with an obstructed flow through the part. 

The cause, however, of the obstructed or retarded flow of 
blood through an inflamed part, has ever been a difficult ques- 
tion in the pathology of inflammation. " The coagulable 
lymph or colorless corpuscles of the blood, which is a con- 
stituent principle of healthy blood, and which has ever been 
considered as the plasma with which old textures are nour- 
ished and new ones are formed, these are found cohering in 
clusters and adhering to the walls of the inflamed vessels. 



Urino-Pathology. 53 



In congestion, these white corpuscles move slowly and slug- 
gishly along the walls of the congested blood-vessels, and if 
not carried through by the momentum of blood, go creeping 
along the sides of these vessels slower and slower, until they 
finally stop one by one perhaps, so narrowing the path that the 
red particles of the blood can no longer pass, then these also 
stick and become so jammed by the current behind, that the 
whole of the vessels become of the deep red color of inflamma- 
tion." These are some of the phenomena, and about the patho- 
logical condition of inflammation as presented by Williams. 

Inflammation is the result of too long continued determina- 
tion or congestion, and is always attended with more or less 
effusion. This effusion is generally at first a thin serum, and 
if the inflammation is slight it may remove it by unloading 
the engorged blood-vessels; this is called resolution. 

In some cases, after inflammation has continued for some 
time, there appears outside of the inflamed vessels white glob- 
ules, very similar to those inside of the sevessels. These are 
called exudation corpuscles, and are supposed by some to be 
consolidated globules of fibrin. This fibrin is at first in a 
semi-fluid and ductile state; so that the motion or pressure of 
the inflamed surfaces draws it into bands or threads, or spreads 
it into films, it having an adhesive property common to glut- 
inous material. The lymph thus effused is considered to be 
highly susceptible of organization, having the capacity of life 
itself. Possessing living properties, its materials arrange 
themselves into the bases of textures; and as the plasticity 
of this lymph depends much upon the good quality of the 
blood, to sustain the life of this texture, it must be supplied 
with healthy blood. For if the blood is poor in quality and 
the inflammation is of a low character, as it is apt to be when 
there is poorness of blood, these products of inflammation are 
less capable of organization, and are susceptible only of a Lou 
degree, resulting perhaps in tubercles, [f the effusion of in- 
flammation goes on to a great extent, pervading the adjoining 
textures, deranging their nutrition, and impairing their colic- 



54 Urino-Pathology. 



sion, softening of the textures take place. If these effused 
matters be retained, and new matters continue to be effused, 
the old texture thus becomes more compressed, and finally dis- 
integrated and absorbed, and large pus-globules alone remain; 
this is suppuration. If the supply of blood be so stopped in 
an inflamed part that the part dies, the dead part may be 
separated from the living textures in the form of a slough. 
If the dead part pass into decomposition before it can be sepa- 
rated, this is called gangrene. If the inflammation be of a 
lower kind, the obstruction less complete, and the effusion 
more general, the nutrition of the textures only impaired, not 
arrested ; it is called induration. These are called the termi- 
nations of inflammation. The varieties of inflammation are 
numerous indeed: Sthenic, asthenic, acute, sub-acute and 
chronic; congestive, phlegmonous, erysipelatous, diptheretic, 
hemorrhoegic, and scrofulous, together with the specific, as 
gouty, syphilitic, rheumatic, and gonorrhoeal. These different 
varieties, each have their peculiarities whereby they are dis- 
tinguished from one another, according to their prominent 
characters, and take on these names in accordance therewith. 
Nutrition. The nourishment and growth of the body may 
be comprehended under the three heads of increased, dimin- 
ished, and perverted nutrition. It is more or less a vital pro- 
cess, and the material on which the growth of a part depends, 
is the blood; and for the activity of the process the depend- 
ence is most upon the supply of arterial blood, the fibrin of 
the blood being the part which constitutes the basis of all 
textures. A rich blood favors nutrition, a poor blood impedes 
it, while a diseased quality of blood depresses it. These causes 
operate on the whole frame, but may affect only a part; in 
fact structural diseases are commonly partial from causes ex- 
isting in the part. Whatever affects the nutrition of a part, 
affects its structure; whatever affects the circulation in a part 
affects its nutrition, therefore these diseases arise from differ- 
ences in the quantity and quality of the blood and the varia- 
tions in its character. Increased nutrition, or excessive natural 



Urino-Pathology. 55 



growth of a part, is called hyperthrophy. When a part is nec- 
essarily more than usually exerted, it generally manifests 
the ability of accelerating its growth, and this circumstance is 
dependent, according to M. Paget, upon these three condi- 
tions : 1st, " The increased exercise of a part in its healthy 
functions ; 2d, An increased afflux of healthy blood ; 3d, An 
increased accumulation in the blood of the particular materials 
which any part appropriates in its nutrition." 

Upon one or all of these three conditions depends the exces- 
sive natural growth, or hypertrophy of any part. In the case 
of diminished nutrition the conditions are somewhat reversed. 
There is a wasting away of the body or a part in all cases of 
atkrophy or diminished nutrition. This may be general or 
partial, in a wasting away of the whole body, as in marasmus, 
or a dwindling away of a part of the body only, as a limb, or 
an organ. 

The cause of Atrophy is divided into the circumstances 
which promote decay, and those which impair or prevent the 
reparatory nutrition. 

A part may become atrophied by disease or want of suffi- 
cient exercise of its functions, for want of sufficient or 
defective supply of blood ; or, because of defect in the form- 
ation of fibrin and albumen of the blood, the plastic mate- 
rials of nutrition. 

Whether hypertrophy or atrophy, the urinary secretion 
always plays its part in the removal of the different kinds 
of debris, according to the nature of the case, or exhibiting 
in its qualities the condition of the blood at the time, and 
consequently the nature and condition of the part. 

In hypertrophy, like in hyperemia, in general, there is usu- 
ally a diminution of this secretion and of its most character- 
istic constituents. Being secreted in less quantity than usual, 
its specific gravity will bo higher, and its color darker than 
natural, and will sometimes approximate in composition the 
urine of inflammation. 



56 TJrino-Pathology. 



In atrophy, however, the urine is different. In these cases 
it will often be found to contain products resulting from the 
decay of the textures. In marasmus, for instance, " from the 
excessive secretions or drains from the body, there is always 
proof of accelerated decay of textures, manifested in the in- 
creased amount of urea excreted by the kidneys." 

Besides the structural lesions of hypertrophy and atrophy, 
there is induration, softening, and the different degenerations, 
all of which are called alterations of the textures. 

In addition to these, there are Deposits in or upon tex- 
tures, which are new matters added to these alterations. By 
deposits are meant the matters which result from an overflow 
of the nutritive material beyond what is necessary to nourish 
the textures themselves. The basis of these is the fibrinous 
matter of the blood, and are divided into : 1st, Those having 
a high organiz ability ; 2d, Those having a defective organi- 
zability, and 3d, Those destitute of organizability. 

There is every gradation in these from the highest capac- 
ity of inherent life belonging to organized bodies, to the most 
degenerated state of the plasma of the blood found in the non- 
fibrinous tubercle itself. 

And we will be much aided in our judgment of these 
grades, by a knowledge of the condition of the blood, and the 
different substances imparted to the urine in each of these dif- 
ferent conditions. 

Signs. — The difference between the signs of health and the 
signs of disease, is determined by our knowledge of what is 
usualin health, and this knowledge is to be derived from our 
experience of a healthy standard. 

There are many signs and symptoms of disease, and it 
behooves the medical practitioner to avail himself of every 
possible means to ascertain the true nature of all cases he 
may undertake to treat. And, while we are claiming for the 
urinary secretion more attention than is generally given to it, 
believing it to be of more value in making up a diagnosis 
in every case, than is usually acccorded to it, we do not de- 



Urino-Pathology. 57 



cry, or wish to detract the value of any other mode. The 
state of the pulse is considered to be an important source of 
symptoms. A slow pulse indicates a deficient excitement of 
the heart, while a frequent pulse indicates the reverse ; a 
strong or weak pulse implies an increased or diminished 
strength of the heart's contractions ; a hard or a soft pulse, 
an increased or diminished tonicity of the arteries ; and so 
on with all the different states of the pulse ; they all indi- 
cate, denote or imply, certain states or conditions of the cir- 
culation ; but of that uncertain and variable character which 
will not alone render a criterion in disease. The same may 
be said of the appearances of the tongue, as also of the al- 
vine evacuations, and all secretions and excretions. 

In a person whose growth is stationary the quantity of 
food passing into the body in a given time, is exactly equiv- 
alent to the quantity of matter passing' 'away in various ex- 
cretions. "The daily six pounds, more or less," says Simon, 
" of meat, bread, coffee, salad, water, etc., exactly correspond 
to the quantity of faeces, urine, sweat, expired carbon, etc." 
Excepting a very small portion which may pass through unal- 
tered, the whole of the food is dissolved in the body, and the 
greater portion is absorbed into the circulation, to renew the 
tissues. The blood as it circulates gives to each organ the 
means of repairing itself, by furnishing it with material of 
new growth. But the blood itself must live and grow, and 
its life and growth must precede all other life and growth in 
the body ; for first it grows, next other organs grow at its 
expense. 

The blood possesses the power of washing away, as it 
were, from each organ, in a dissolved state, whatevar ele- 
ments of its tissues have become wornout and useless. These 
are passed off in the excretions. If you take into the 
stomach a little rhubarb or iodide of potassium, and find 
traces of the drug in a few minutes in the urine, you knou 
that it must have traversed the circulation, been absorbed, 
dissolved in the serum, and literally to have formed part of 



58 Urino-Pathology. 



the blood during the time elapsed between its absorption and 
its discharge. The same thing occurs in the natural process 
of organic conversion. In the chemical changes which occur 
in the active tissues of the body, the disintegrated particles, 
in order to reach the kidneys, for elimination, must first form 
a part of the stream of circulating blood. This passage of 
particles through the circulation, and its elimination, by the 
kidneys, is extremely rapid, in some cases, especially in that 
of some poisons, the elimination by that organ being as rapid 
as its absorption by another — a wise provision of nature, in- 
deed, for the preservation of the integrity of the blood, and 
the safety of the body. 

BLOOD.— " The blood is the life." The heart is the foun- 
tain-head from which this vital fluid issues. The right auri- 
cle of the heart, is the part first seen to pulsate in the 
embryo, and in death it is the last to retain its motion. 

The commencement of the circulation of this vital fluid, 
then, may be regarded as the beginning of active life, and 
its cessation, the end; the blood itself being the support of 
all the vital properties, or phenomena belonging to animal 
existence. 

In the constituent elements of healthy blood, are contained 
all the vital properties of the elementary solids of the body, 
while in the morbid elements of the blood may be traced all 
the elements of disease. 

All diseases, therefore, are manifestly first in the blood. 
And, as from the blood is secreted the urine, through the 
medium of the kidneys, an acquaintance with the constituent 
principles of the blood itself, both in health and disease, is 
of vital importance to the student of medicine, and indispen- 
sable to the proper understanding of the Uroscopian System. 
It will not be our province, however, to give a minute de- 
scription of these, nor to describe the process of analyzation 
of the blood, as many valuable works have already been writ- 
ten thereon, but only to give a mere statement of some of 
the more important facts that seem to be called for in the 



Urino-PatJiology. 59 



elucidation of our subject. And the first of these will be 
found in the adoption of the average natural proportions of 
the chief constituents of the blood in health. 

The many and repeated analyses of the blood, by the cele- 
brated Lecanu, which enabled him to form a " standard of 
proportions" of the chief constituents of healthy blood, the 
correctness of which, all the analyses of both the celebrated 
authors, Andral and Gavarret, have but the more fully sub- 
stantiated, and which standard they adopted, will be a suffi- 
cient guarantee for its adoption here. 

This proportionate standard is as follows : 

Red globules, . . . .127 parts in 1,000. 

Fibrin, 3 " " 

Animal matter in the serum, . 72 " " 

Salts, 8 " " 

Water, 790 " " 

Now, the above being the average natural proportion of 
the chief constituents of the blood in health, any considera- 
ble deviation from this standard may be regarded as disease ; 
and the extent of such deviation a tolerably-fair measure of 
the extent of the disease. 

The red globules appear to be the part of the blood upon 
which its vivifying properties chiefly depend. Their propor- 
tion is from ten to twenty parts in one thousand, less in 
females than in males, an important fact necessary to be 
borne in mind during examinations of the urine. 

These red globules are always in excess in sanguinous 
plethora, in some instances rising, it is said, to one hundred 
and eighty-five parts in one thousand of blood ; while in 
other instances, such as after great loss of blood or in chlo- 
rotic and anemic diseases, they have been found by Andral, 
to be reduced even to twenty-seven parts in one thousand 
of blood. The former represents force and strength, the lat- 
ter feebleness and debility. 

The remarkable diminution of the red particles of the 
blood, which sometimes takes place, is generally due to the 



60 Urino-PatTiology. 



draining away of the albumen of the blood, through the 
medium of the kidneys, which albumen is always perceptible 
in the urinary secretion, and may be detected by the appro- 
priate chemical tests, or microscopic appearance. (See Chart, 
Fig. 10.) 

When the red particles are in excess in the blood, there 
will be no albuminous substance to be detected in the urine, 
but generally an abnormal quantity of fibrinous matter or 
other properties exhibited in that secretion, indicative of an 
inflammatory condition or plethora, in extent according to 
such abnormality in quantity or quality of the substances 
thus cast off in that fluid. 

In Williams' Principles of Medicine, page 158, he says : 
" The blood is probably the chief seat of the morbid poisons 
which excite various contagious, epidemic and endemic dis- 
eases. Probably, too, it is the hot-bed in which some of them 
are propagated, whether by seeds, ova, cell-germs or parasites ; 
and it is through changes in its composition, ( the blood ) that 
many of the destructive effects of these poisons are pro- 
duced." 

In the treatment of foreign morbific matters in the blood, 
the same author says : " The two indications which present 
themselves are — first, to counteract the injurious operation of 
these matters ; and, second, to expel them from the system. 
The first of these indications is followed when we give stim- 
ulants to overcome the depressing influences, etc. ; the other 
indication is more generally pursued, although little recog- 
nized by practitioners, to-wit: to expel the offending matter 
from the blood. The excretory organs, especially, the kid- 
neys, and alimentary canal, are the principal natural emunc- 
tories through which foreign and offending matters are 
expelled from the blood, and hence the great utility in aperi- 
ents and diuretics, in the treatment of fevers and other dis- 
eases connected with injurious matters in the blood." 

Orfila found that the pernicious effects of small and oft- 
repeated doses of arsenic, might be averted, by giving at the 



Urino-Pathohgy. 61 



same time, a diuretic medicine. How often do we see fevers 
and other serious ailments, carried off by even a spontaneous 
diuresis. And this is effected by the removal of the delete- 
rious matters from the blood, through the medium of the kid- 
neys and urinary organs. 

The great variety of changes that may occur in the blood, 
is not more than equalled in the variety of diseases that 
afflict the human family. Even the coloring matter of the 
blood is evidently altered in many ways, and is changed in 
many diseases. In the worst forms of scurvy, it is said, by 
Mead, to be changed to a dark-brown, or green color ; and 
in the Walcheren fever it was described as being pitchy 
black. 

In the worst form of cachexia, the blood is not only poor 
but perverted, exhibiting various shades of purple, brown, and 
even greenish colors. All these have their significance, 
pathologically, and must be taken into account. Also, the 
positively noxious properties which excrementitious matters 
retained in the blood, are known to possess. 

One of the most interesting facts connected with the patho- 
logy of the epidemic fever which prevailed in Edinburg, in 
the year 1843, is said to be the discovery of urea in the 
blood. " The existence of urea in the blood," says M. W. 
Taylor, "in other cases has been inferred from occurrence 
of disorders of the nervous centers, which Ave know to be the 
consequence of its undue accumulation in the circulation. 
These phenomena have been observed in those cases in Avhieh, 
from some cause or other, the daily discharge of urine has 
undergone material elimination." 

It is well known that the blood in dropsical affections exhib- 
its a deficiency of the usual proportion of albuminous matters, 
and that in such oases there is found in the urine considerable 
quantities of thai substance. So general has a knowledge of 
this become, that nearly every physician now tests the urine 
in dropsy, and treats the case accordingly. 



62 Urino-Patliology. 



Dr. Blackall, in speaking of this circumstance, says : " Let 
me add once for all, that in the instances of cure (of dropsy) 
by digitalis, the improvement of the urinary discharges is sim- 
ultaneous with the relief of the other symptoms, certainly not 
subsequent to them, but always among the earliest good 
signs." 

Having given the standard of the chief constituents of the 
blood in health in page 59, an excess of any of these constit- 
uents over the proportions there given, may be considered 
abnormal in quantity, and therefore declarative of one form 
or kind of disease, while a deficiency of the proportionate 
quantity of the same constituents would be declarative of a 
reverse kind. Thus, "in some forms of disease, as for ex- 
ample in anemia and chlorosis, the proportion of water is 
usually much greater, and has been known to amount to up- 
wards of nine hundred parts in one thousand ; while in cer- 
tain other pathological conditions, on the contrary, the blood 
is found to contain considerably less water than is present in 
the healthy blood ; as in cholera, for instance, where the blood 
is so rich in solid matter as almost to resemble jelly in ap- 
pearance, it has been known to contain not more than four 
hundred and eighty parts of water in one thousand of blood." 
( Bowman.) 

The same author says : " In disease, especially some forms 
of fever, the proportion of red corpuscles sometimes increases 
considerably, and has been known to amount to one hundred 
and eighty-five parts in one thousand of blood (one hundred 
and twenty-seven being the average), while in certain other 
affections long known as having been attended with great 
poorness of blood, the proportion of red corpuscles frequently 
does not amount to more than sixty or seventy parts, and 
has been known to be as low as twenty-one parts in one 
thousand of blood." 

The average proportion of animal matter or albumen in 
healthy blood being seventy-two parts in one thousand, ac- 
cording to the given "standard," in some diseases it is as 



Urino- Pathology. 63 



high as one hundred and thirty-one, "while in others, as in 
Bright's disease, it is sometimes as low as fifty-five parts in 
one thousand. The amount of deficit of this substance in the 
blood in this latter disease, is always connected with a cor- 
responding amount of the same substance, discoverable in the 
urine. And it is by the quantity of this substance being 
thus cast off that the magnitude of the disease may be quite 
correctly estimated." 

Minute traces of urea are thought by some probably to 
be always present in healthy blood, but the quantity is very 
small, while in some forms of disease, especially those in 
which the functions of the urinary organs are to any extent in- 
terfered with, the amount of urea is found to be cors'derably 
increased, "and may frequently be met with," says Bowman, 
"in a sufficiently large quantity to be weighed." 

The average proportion of fibrin in healthy human blood 
being three parts in one thousand, it has been known to vary 
from a mere trace to upwards of ten parts in one thousand of 
blood. A considerable increase in the amount of fibrin in the 
the blood is always found in every form of imflamatory dis. 
ease, and a corresponding deficit of that constituent in reverse 
diseases, or those of a non-imflamatory or anemic char- 
acter. 

The average proportions of salt being eight parts in one 
thousand of healthy blood, in scurvy and some other patho- 
logical conditions, their amount has been found increased to 
as much as eleven or twelve parts in one thousand, while 
in other diseases the amount many times falls much below 
the healthy standard. 

Learning the chief constituents of healthy blood, and the 
relative proportion each bears to the other, and that each is 
subject to changes of proportion, either in excess or deficien- 
cy, and that such changes are characteristic of different dis- 
eases, the necessity of searching for the source of removal of 
eaid constituent in the case of its deficiency, or the cause of 



64 Urino-Patholoyy. 



its redundancy when in excess, will be apparent to every in- 
quiring mind. 

When in connection with these we find that in anemic or 
chlorotic diseases, in which the blood is poor in corpuscles 
and excessive in water, the urine is scanty and loaded with 
coloring matter, indicative of a retention in the system of 
the one, and a drainage from the system of the other ; and 
when in dropsy or albuminaria, the blood is found to be de- 
ficient in albuminous matter, while the urine is loaded with 
that substance ; as also in inflammatory diseases, in which 
the blood loses its fibrous property, and said substance is 
found to be deposited in the urine ; and, as also, the same 
general rule is observed in scorbutic and other diseases, in 
which the salts have been found in excess in the blood, and 
a corresponding deficit of the same in the urine, and vice 
versa; when we find all these facts and numberless others 
of a like significant character, we feel confident in the cor- 
rectness of the general principles, and hope to make them 
valuable in practical results. 

But apart from these facts, which are the result of the 
experience of many eminent authors upon the subject, an- 
other circumstance connected with the relative conditions of 
the blood and urine deserves our attention, namely : morbid 
blood, containing abnormal ingredients. 

Blood not only becomes morbid by an excess or deficit of 
any one of its natural constituents, but it is subject to morbid- 
ity by its reception of ingredients foreign to its composition. 
And in this condition of the blood, a different state of circum- 
stances exist, and a different rule of action is set up. The in- 
gredient contained in the blood being abnormal, or being 
foreign to the composition of the blood, the kidneys being the 
emunctories whereby foreign or morbific matters are removed, 
portions of these abnormal ingredients will be found in the dis- 
charges therefrom. And commensurate with the quantity of 
said abnormal ingredients in the blood, so will the relative 
quantity of the same substance be discovered in the urine. 



Urino-Pathology. 65 



Thus, "the blood of patients suffering from Diabetes, appears 
mostly to contain a very sensible amount of sugar, and this 
substance may in such cases very readily be detected in the 
urine." (See Diabetes.) And so it is in jaundice and some 
other affections in which the functions of the liver are inter- 
fered with, an accumulation of biliary matter is found to have 
taken place in the blood, giving to the serum a more or less 
decided saffron or orange-brown color, "which is due to the 
peculiar coloring matter of the bile," says Bowman, and which 
may be readily detected in the urine by appropriate chemical 
tests. And thus it is with pus, fat, or any poisouous sub- 
stance, of whatever kind, that may have entered the blood, 
whether by food, drink, medicine, malaria, or the decayed 
particles of other parts of the human system, and which it is 
the office of the kidneys to secrete and the urine to carry off. 

The human system is continually undergoing the process of 
reparation and decay. The elements of food being absorbed 
by the lacteals, reach the right side of the heart, and being 
exposed to the influence of the air in the lungs, become con- 
verted into blood. "From the blood all the tissues of the body 
are formed, and the waste of the animal structure supplied." 
Before this nutrient substance can be deposited, room must be 
made for it by the removal of old and exhausted material. 
The blood is sent out from the heart through the arteries, 
highly charged with the necessary elements for the full sup- 
ply of all the wear, tear, and decay of this body, as is evi- 
denced by its bright and lively florid colors, ; and on its re- 
turn through the veins, it takes up the decayed particles from 
every tissue, thus virtually making room for its load. That 
the blood thus regularly unloads itself of its vivifying proper- 
ties on its outward-bound trip from the heart, and gradually 
re-loads on its return through the veins with decayed particles, 
poisons, or whatever debrs or deleterious substances it may have 
met on the way, is fully evidenced from the great change of 
color and other properties it undergoes in the round, being 



66 Urino-Pathology. 



darker, almost amounting to a black as it approaches again 
the heart. 

A paucity or excess of one of the constituents of the blood, 
or its contamination by morbid influences or foreign substan- 
ces, constitute the essential cause of every disorder which 
afflicts the human family. And the peculiar symptoms which 
enable us to distinguish one particular disease from another, is 
the result only of such paucity or excess, or morbid influence 
on the blood. And the urine being secreted from the blood 
only, under all these circumstances, in consideration of the of- 
fice which it is detailed especially to perform, to-wit : " re- 
moving from the blood superfluous and unhealthy matter," it 
is plain that these differences must be characterized in this 
eliminating fluid. 

Now, as the real cause of a departure from health is first 
manifest in the blood ; and as such cause, whether by change 
in the constituent principles of, or foreign substances in the 
blood, is early made known in the urine, even before the symp- 
toms by which we generally characterize the disease, is made 
known upon any other part of the system ; or rather, as Black- 
all says, "as the change in the urine is among the earliest 
symptoms of certain diseases," and as "the state of the urine 
is also generally among the first and most convincing signs of 
improvement in disease," and as "without any particular refer- 
ence to the other symptoms, and even when the patient has not 
been visited," (says the same author,) "the state of the urine 
itself furnishes us an important indication of the disease," and 
as the kidneys excrete the only substance containing particles 
from all parts of the system in sufficient quantities for the 
practical purpose of diagnosing diseases, and as the condition 
of those particles exhibits the true condition of whatever part 
they proceed from, will any one say that it is not of the utmost 
importance, in all cases, to examine the urine, in order to 
arrive at the true cause of disturbance in the animal econ- 
omy? For there is no change that can take place in the 
blood, either in the constituents of the blood itself, or by for- 



Urino-Pathology. 67 



eign matters, which have merely entered its circulation, but 
that evidence of the same, or traces of the substance is to 
be found in the urine, even poisons, arsenic, etc., which, ac- 
cording to Orfila, "are carried off largely by the renal secre- 
tions." 

The dark color and thick consistence in blood in Asiatic 
cholera ; the paleness of the blood in chlorosis ; the whitish 
leather-like pellicle which covers the blood in pleura-pneu- 
monia ; the yellowish appearance of the blood in jaundice; the 
dissolved state of the blood in scorbutus ; the reddish, dirty- 
water appearance of the blood in anemia ; the deficit of albu- 
men in the blood in dropsical and other diseases, etc., etc., are 
so many evidences of the different morbid conditions of the 
blood in different diseases, that we do not hesitate to pro- 
nounce that all diseases manifest themselves first in the blood, 
and that the continuance of disease is cotemperaneous with the 
continuance of the altered condition of the blood; and that 
the cure of any disease will only be effected by a restoration 
of the blood to its normal condition. 

The whole amount of blood in the human body has been 
reckoned to average about thirty pounds; the quantity pro- 
jected by the heart at each systole, to be from one to two 
ounces. Therefore, calculating the pulsations to be seventy- 
five per minute, it would take only from three to seven min- 
utes for all this blood to pass through the heart. Now a 
constant metamorphosis is going on in the living blood. 
When it ceases to undergo this metamorphosis, it dies ; but 
the blood is not the only portion of the body that undergoes 
this change; every organ and tissue -is subjected to a similar 
metamorphosis, which is presented to us under the general 
phenomena of nutrition and consumption, or reparation and 
decay, and which is dependent on, and effected by the Mood 
alone. 

But, since the various tissues present a different chemical 
composition, and since the different organs Separate different 



68 Urino-Pathology. 



matters from the blood, it is obvious that they can not all 
modify this circulating fluid in the same manner. 

In the conveyance of nutriment to the various parts of the 
organism, the blood, in its passage through the capillary net- 
work, permeates all organs and tissues, and their cells take 
up from the plasma those substances which they require for 
nutrition, and restore to it those which have become effete, 
and are no longer adapted for the process of nutrition. 

Now, in view of observations already made, in regard to the 
position of the kidneys in the human system, the great cal- 
iber and short course of the renal artery, the connection with 
the liver, spleen, omentum, etc., and that, according to some, 
the fifth part of the whole blood passes through the kidneys, 
that at each systole of the heart five or six scruples of blood 
are driven into them, together with the peculiar structure and 
chemical constitution of these organs themselves, permeated 
as they are by such an extremely abundant and dense capil- 
lary net-work, and such very delicate venous twigs, so closely 
encircling their excretory ducts that the tissue is brought in 
contact with this blood at every point and in every direction, 
we must infer that the blood thus may not only undergo a 
much more rapid metamorphosis in the kidneys themselves, 
than in any other organ of the body, but that the kidneys 
the more readily separate the metamorphosed particles from 
other organs and tissues with which this blood is surcharged 
than is likely to be done by any of the other excretory glands 
of the system, and that by an examination of this secretion 
the mind of man is enabled to penetrate more deeply into the 
pathological conditions of the human system, and to learn the 
material deviations from a normal state with greater accu- 
racy than can be attained in any other way. 



t Urino-Pathology. 69 



URINE. 

66 The urine is by far the most compound of all the secre- 
tions," says Dr. Aikin, "draining off, as it does, particles 
of every tissue which the absorbents take up from all parts 
of the body, as wornout, redundant and useless." 

The position of the kidneys in the human system, the con- 
nection of the right kidney to the liver, which rests on it, 
as it were, and the left on the spleen, and both, to the supra- 
renal glands, by a cellular tissue, gives to these organs a supe- 
riority of position over many others, in their anatomical con- 
nection as well as physiological consideration. 

The blood-vessels of the kidneys are very large in propor- 
tion to the size of these organs themselves, the renal artery 
being one-eighth the size or caliber of the great aorta of the 
body. It is also very short compared with any other artery 
of the same size. And from this short course and the pe- 
culiar distribution of its branches, together with the great 
size in proportion to the kidneys, it is peculiarly well adapted 
to that quick and copious secretion of fluid which the kid- 
neys so readily separate from the blood. 

The renal artery and its branches so freely communicate 
with the veins, and so readily open into the excretory ducts 
or conical nipples, from which the urine being now separated 
from the blood, trickles into the funnels, thence into the 
basin, thence through the ureters into the bladder, and by 
this short course, afford so ready a passage for the evacua- 
tion of so large a quantity of a fluid which has been secreted 
from so large a volume of blood, the kidneys can not but 
be regarded as the great balance-wheels, as it were, the reg- 
ulators and the purificators of the circulatory system, but 
their secretion, as the indicator of the health and strength 
of the whole animal economy also. 

This character of these organs is more fully strengthened 
the more wo examine their adaptation to these purposes aud 
the further we pursue the investigation into their physiolog- 



70 Urino-Patholoyy. 



ical condition, and connection with the circulation of the 
blood ; whether in view of the offices they fulfil ordinarily, or 
their ability to act as a compensating functionary under more 
than ordinary circumstances. 

"The kidneys," says Dr. Aikin, "constituting as they do, 
important emunctories or channels by which superfluous or 
hurtful matters are discharged from the blood, it is neces- 
sary that their function should be carried on without inter- 
ruption, as is found to be the case in health — for the con- 
stant deposition of new, and the absorption of the old mate- 
rials, demand the unceasing evacuation of the old wornout 
particles from the general mass of the circulating fluids." 
Neither can the function of the kidneys be suspended for any 
length of time without injury to the constitution ; for when 
this secretion is suspended, or its evacuation obstructed, great 
distress is sometimes experienced in the whole system ; because 
of all the fluids the urine is that which hastens most speed- 
ily into putridity, symptoms of decomposition taking place, in 
some instances, even before the extinction of life. 

And, when death does take place, from a suspension or ob- 
struction of this secretion, "the body rapidly passes into a 
state of offensive putrefaction, indicating how important to the 
health and well-being of the whole frame the due perform- 
ance of the function of the kidneys necessarily is." 

"The urine is a fluid," says Markwick, "composed of cer- 
tain effete animal and saline matters which have been sepa- 
rated from the blood by the kidneys," and "as it carries off 
from the system," (says Aikin) "the debris of the body, so 
does it vary in different states of the constitution." 

When any one organ becomes diseased, its vitality being 
lessened, it will have less power to resist the tendency to 
decomposition, hence there will be more of these diseased par- 
ticles passed from this organ than from the healthy parts. 
And, as the different parts of the system are of different 
composition, colors, etc., so much so that almost any person 
can distinguish, merely by their appearance, the lungs from 



Urino-PatTiology. 71 



that of the heart, liver, brain, kidneys, etc., or one of them 
from another, so the refused fluid, or diseased particles of 
these parts are also different one from another; and are as 
capable of being distinguished from each other, by their ocu- 
lar appearances, chemical tests, or microscopic characters, and 
the different qualities of each may be as clearly ascribed to 
its different locality or organ, by a practical Uroscopian, as 
can a practical chemist, by an analysis of the waters of the 
earth, determine the presence, in the vicinity of said water, 
of salt, lime, sulphur, iron, etc., or a microscopist, by the lacu- 
na? and canaliculiy their shape and size, determine to what 
class of bird, beast, reptile or fish, any given piece of bone 
belongs. 

The waters of the different medicinal springs, the Spa, 
Seltzer, Harrowgate, Bedford, Cheltenham, Saratoga, etc., are 
readily distinguished by their appearance, color, taste or odor, 
and the chemist is enabled to determine the different ingre- 
dients composing each, and the definite proportions of the 
same ; which ingredient predominates, and to what extent is 
the deviation from pure water. The same may be said of a 
practical Uroscopian. 

Dr. Simon says ; " The analysis of urine seldom presents 
any very great difficulty. Many of its constituents may be 
detected with ease, unless, as is sometimes the case, they exist 
in very minute quantity." It is something like that of the 
mineral waters, some of the constituents may be at once recog- 
nized, even without any test, others by the addition of a 
simple test, while the presence of others may require to bo 
separated and isolated, and viewed under the microscope. 
" During disease the urine may undergo numerous modifica- 
tions, both in its physical character and its chemical consti- 
tution." The chemical changes may bo reduced to one of 
the following forms : 

1st. One or more of the normal constituents of the urine 
existing in larger quantity than in healthy urine. 



72 Urino-Pathology. 



2d. One or more of the normal constituents existing in 
less quantity than in healthy urine. 

3d. A normal constituent absent. 

4th. The presence of substances that do not exist in nor- 
mal urine. 

Of the first, the deep-brown color will indicate the abun- 
dance of solid matters. Of the second, the pale urine, or 
more water-like, will indicate their deficiency; but the com- 
mon urinometer is sufficiently accurate to determine the ex- 
cess or defect in either, by giving the specific gravity. 

The practitioner should not only be able, by examination 
of the urinary secretion, optically, chemically, and microscop- 
ically, if need be, to determine the character of a given speci- 
men, whether the constituents of healthy urine be present ; if 
so, whether in due proportion ; if not, in what the deviation 
consists, but also, the extent of such deviation from the natu- 
ral standard — which would at once give a clue to the nature 
of the disease, or the cause of departure from health. 

It has been stated by Dr. Buchan, in his " Domestic Medi- 
cine," "that the passions, the atmosphere, the food, clothing, 
state of the evacuations, and numberless other influences, tend 
to so change the quality of the urine as to render it an uncer- 
tain criterion in disease," etc. Now, these same influences tend 
to, and do change the condition of the patient at the same time, 
and precisely in the same ratio of the change in the urine. Is 
it pretended that a violent fit of anger will change the appear- 
ance of the urine, without producing any change upon the ner- 
vous system ? Or, that a sudden change in the atmosphere will 
produce a marked change in the appearance, quality, or con- 
stituent principles of the urine, without producing any impres- 
sion upon the constitution or some one or more of her organs ? 
And the same questions may be asked in reference to food, 
clothing, state of evacuations, etc., etc. All these produce 
certain impressions upon the constitution, by making certain 
changes in the circulating fluid, the blood ; hence the change in 
the character of the mine, which change in the urine is the in- 



Urino-Pathology. 73 



dex to the character of the disease, or peculiar condition of the 
system at the time. 

The statement of Dr. Buchan was copied by Dr. W. Beach, 
and published in his " Family Physician," a number of years 
ago. Afterward his attention was called to the subject by the 
author of this work, in a letter written to him in the year 1844. 
In his answer to said letter, Professor Beach says : " With re- 
gard to what I have said in my work, page 59, etc., I am now 
willing to stand corrected on the point referred to in your let- 
ter. I may have been too sweeping and wanting in discrimina- 
tion. If so, I am ready to retract." 

Several years after the above was written, and when he had 
more fully investigated the subject, he publishes the following 
retraction, in his more valuable work, " The American Prac- 
tice," Vol. L, page 175 : "To the class of physicians who are 
called Uroscopians, and depend mostly on this secretion (the 
urine) to form their diagnosis, we owe an apology for ridiculing 
their pretensions. We have since learned, though no doubt 
some are extravagant, that they are enabled to discriminate 
between diseases by an examination of the urine ; and the great- 
est physiologists in Europe now pay particular attention to the 
quantity and quality of the urine in disease." 

Disease is the antagonist of life, and the life of a person is 
the blood — the complete destruction of the blood being death. 
Every attack of disease is an attack upon the blood, and upon 
the repulsion of such attack depends tlie life of the body. 
Therefore, to arrive at the precise condition of the blo.od in any 
disease, should be the first object of the physician, as by such 
knowledge he is put in possession of the data whereby its repul- 
sion is best accomplished. That the urine is secreted from the 
blood, and that the blood and the urine are both definitely and 
almost simultaneously altered in composition, in nearly every 
different disease, that any deviation from the natural standard 
of the chief constituents of the blood in health involves a cor- 
responding deviation from the natural standard o( the chief 
constituents of the urine in health also, are facts which seem 



74 



Urino-Pathology. 



to be well established by theory as well as practical experi- 
ments and observations. To arrive, then, at a correct know- 
ledge of the different proportionate ingredients of urine, in its 
various deviations from the healthy standard, will put us in 
possession of a tolerably correct knowledge of the state of the 
blood at the time. 

The average proportion of the constituent principles of urine 
in health, is given in the following table, as approximating a 
standard at least, which is sufficiently applicable to all general 
purposes, and sufficiently specific for all practical purposes ; the 
average density, or specific gravity, being placed at 1,020 (water 
being 1,000), in adult males, a little less in females, and still less 
in children, according to age, etc. 

TABLE . 

Water, - - 956 parts in 1,000 of Urine. 

Organic Matters, 30 

Fixed Salts, - 14 

The Organic Matters are composed of the following ingre- 
dients, and in about the following proportions, to wit : 

Urea, - - - 14.5 parts in 1,000 of Urine. 



1 ,«■ " 

y \s ° 

J "1 " 



Uric Acid, 


•4 1 


^ 


Extractives, 


14 


i 


Mucus, 


.2 


► .2 

1 


Muriate of Ammonia, 


.9 J 


O 




30. 


ae Fixed Salts about 


as follows 


Chloride of Sodium, 


7.3^ 




Phosphoric Acid, 


2.2 




Sulphuric Acid, 


1.8 


fl 


Lime, 


.3 


3 


Magnesia, 


.2 


s 


Potassa, 


2. 




Soda, 


•2, 





parts in 1,000 of Urine. 



14. 



Urine-Pathology. 75 



Be it remembered, that the above table represents the aver- 
age proportion of ingredients in healthy urine, and is adopted 
as the " Standard." It is divided into three general parts, to- 
wit: Water, Organic Matters, and Fixed Salts, that the more 
minute and specific ingredients may be classified therein. By 
an acquaintance with the optical qualities merely, a single 
glance at the urine, will [sometimes enable one to desig- 
nate the probable course of deviation from the healthy stand- 
ard, whether too aqueous or too solid, too light or too dense, 
etc., and from these significations, to determine to which of 
these divisions it belongs. Dr. Bowman says: " The urine 
passed during a diseased state of the system is almost invaria- 
bly more or less altered in its composition, and frequently pre- 
sents physical peculiarities, as of color, opacity, etc., which are 
at once apparent on the most cursory examination." 

The slightest deviation from the appearance of the urine in 
health, is so apparent to the eye, that nearly every person 
has been a casual observer of the fact in his own case, when 
" not well." 

How many of the unlettered, even, have learned to attach 
great importance to the change in the appearance of their 
urine, from having accidentally observed it perhaps when sick, 
describing it as being too pale or too red, too light or to dark, 
milk-white or muddy, etc. 

Whenever the natural ingredients of urine maintain their 
proper relation to each other, that fluid will be of a clear 
but somewhat pale amber-color, something like sherry wine. 
Its transparency, however, will be slightly affected on cooling, 
by the gradual subsistence of a slight mucus cloud, derived 
from the bladder or perhaps the urinary passages. 4 * When- 
ever, however," (says Bird,) "one or other of the ingredients 
exists in real or comparative excess, or a new substance is 
superadded, the urine does not generally remain clear, but 
either immediately on being voided, or at least upon cool- 
ing, becomes more or less turbid." "It is likewise consid- 
erably influenced by disease," says Markwick, " being panic- 



76 Urino-Paihology. 



ularly strong in color and odor, in all cases of fever and 
inflammation, for instance, and almost entirely wanting in 
both these characteristics in anemia, hysteria, etc., "while in 
diabetes, immediately after the urine is voided it sometimes 
resembles whey in color, and subsequently, when fermentation 
commences, is of an alcoholic nature." 

The color of the urine depends somewhat on the degree 
of concentration, and hence the the necessity of ascertaining 
its specific gravity. This is placed, as before remarked, at 
one thousand and twenty in males at adult age, as the "stand- 
ard." This density is a little lessened in females of the same 
age, but not sufficiently in every case to distinguish the sex of 
the patient, so many other circumstances tend to produce the 
same difference in urine. 

The urine passed in the morning, or after a night's rest, 
called by writers, urina sanguinis, as having come more 
from the whole of the blood, when the system was in a state of 
repose, and less likely to be influenced by exercise or excite- 
ment, is that which should always be preferred, as furnish- 
ing the fairest specimen of the average density, etc. 

As the average specific gravity of healthy human blood is 
less in the female than in the male, so is the average specific 
gravity of the urine also less in the female. The female has 
been considered the "weaker vessel," and it would seem to 
be so in point of fact, as well as anatomically, in the struc- 
ture of the human frame — physically in the formation of the 
muscles, chemically in the constituents of the blood, or men- 
tally, as is considered by some, in the " power of the brain." 
The bone is more rounded in form, the muscle is finer in 
texture, and the blood is lighter and weaker, and the urine 
is lighter in color, and its average specific gravity is less. 

Having set forth, in some measure, the general principles 
upon which the system of Uroscopia is founded, we will give 
a concise view of the mode of procedure in the clinical exam- 
ination of a specimen of urine, and the determination of the 
nature of the disease. 



Urino-Patliology. 77 



On the presentation of a specimen of urine for examina- 
tion, the name and age of the patient is obtained and recorded 
in a book, leaving sufficient space for a record of the quality 
of the urine, the symtoms and nature of the disease, and in 
practice, the prescription of medicine. The name of the 
patient serves for convenience of reference in after examina- 
tions, and the avoidance of confusion in subsequent prescrip- 
tions that may be required. 

A knowledge of the age is necessary, inasmuch as even 
healthy urine varies in composition in children, adults and the 
very aged ; it being more aqueous in children, more acrid and 
solid in adults, and more fetid, etc., in very old persons. And 
besides it serves the better to fix a pro rata " standard" of the 
urine, according to such age, and also to regulate the doses 
of medicine in accordance with the same, when medical aid 
is required. 

We then place the urine in a test-tube, and take observation 
of its color and opacity, the deepness or paleness of the one, 
the lightness or heaviness of the other, which will alone many 
times enable us to determine very correctly the class, at least, 
to which such specimen belongs. Be that as it may, how- 
ever, as yet, we then examine its specific gravity, by im- 
mersing therein the gravimeter or urinometer, which is a small 
glass instrument with two balls and a narrow stem, the stem 
being marked by degrees corresponding to the depths it will 
sink, according to the density of the fluid. This gives us a 
knowledge of its density or specifiic gravity, and in addition 
the assistance it renders us in the classification of the spec- 
imens, "puts us in possession," says Bird, "of the data 
necessary for the calculation of the proportion of solids ex- 
creted by the kidneys; and this not unlVequently enables the 
physician to detect a previously unsuspected cause oi' emaci- 
ation." 

After the specifiic gravity of the urine is obtained, the 
acidity, alkalidity or neutrality of the same may he tested. 
This is done by immersing in that fluid bine and red litmus- 



78 Urine-Pathology. 



paper. If the urine be acid, the blue color of the paper 
will be changed to red ; if alkaline, the red will be changed 
to blue; but if no change occurs in either, the urine is 
neutral. 

A knowledge of the state of the urine in this particular, 
is highly important in itself, but more especially in connec- 
tion with subsequent chemical analyses of the deposits, as it 
forms a guide for the selection of tests, and the direction of 
experiments therein. 

From the color, opacity, cloud, pellicle, or deposit; quality, 
odor, freshness or putridity; acidity, alkalinity or neutrality 
of the urine, a tolerably close conjecture at least, may be 
made as to the character of the fluid; which a few well- 
directed experiments will generally be sufficient to decide. 

If the urine be very high-colored, blood may be suspected ; 
if so, a dark coagulum will be found on boiling in a vial or 
test-tube. 

If on boiling, the dark coagulum be not present, and on 
adding a little hydrochloric acid, a decided red color is 
formed, it is only an excess of coloring matter. 

If there are any traces of a pink color present, the addi- 
tion of a warm solution of urate of ammonia will throw down 
a pink-colored precipitate, called purpurine. 

If the specific gravity be higher than one thousand and 
twenty-five, urea may be suspected to be in excess ; if so, 
by the addition of an equal bulk of nitric acid, keeping the 
glass cool by allowing it to float in water, a crop of crystals 
of nitrate of urea will, in a short time, appear. 

If urea be not found, sugar may be suspected; when by 
mixing one-third part of liquor-potassa with the urine and 
boiling it quickly, for five minutes, the liquid will assume a 
brownish or bistre tint, if sugar be present. 

If the urine be fully acid to test-paper, and a precipitate 
be formed on boiling, and by the addition of nitric acid the 
precipitate is dissolved, the earthy phosphates are in excess. 

If the urine be alkaline to test-paper, and a coagulum is 



Urino-Pathology. 79 



formed on boiling, and by the addition of nitric acid the co- 
agulum is not dissolved, albumen is present 

If the urine be alkaline and no coagulum be found on 
boiling, and a precipitate is thrown down by nitric acid, the 
production is uric acid in excess. 

If bile be present in a given specimen of urine, it gener- 
ally gives a more or less decided yellowish-brown color. To 
determine, pour a few drops of the urine on a white plate, 
and then carefully add a few drops of nitric acid; the liquid 
becomes successively pale-green, violet, pink and yellow, the 
color changing rapidly as the acid mixes with the urine. If 
the deposit of urine upon cooling, be a mere floculent, cloud- 
like substance, easily diffused again on agitation, not disap- 
pearing on the addition of nitric acid, it is chiefly made up 
of healthy mucus, epithelium, or in women, an admixture of 
leucorrhceal discharge. 

" If the deposit is ropy, and apparently viscid, add a drop 
of nitric acid ; if it wholly or partly dissolves, it is composed 
of phosphates, if but slightly affected, of mucus. If the de- 
posit falls like a creamy layer to the bottom of the vessel, 
the" supernatant urine coagulable by heat, it consists of pus." 

" If urine, on cooling deposits a white sediment, it is urate 
of ammonia, phosphates or cystine. The first disappears on 
heating the urine, the second, on the addition of dilute nitric 
acid, while the third dissolves in ammonia, and the urine 
generally evolves an odor of sweet-brier. 

"If the deposit be colored, it consists of red particles of 
blood, uric acid, or urate of ammonia, stained with pui purine ; 
if the first, the urine becomes opakc by heat ; if the second. 
the deposit is in invisible crystals ; if the third, the deposit 
is amorphous, and dissolves on heating the fluid." 

The apparatus and reagents required for a superficial ex- 
amination of the urine, are but few; in fact, nearly all the 
necessary tests and experiments can be conducted in a sat- 
isfactory manner, in a very short time, and with but few in- 
struments or reagents : 



80 Urino-Pathology. 



A Urinal or two, holding two or three ounces. 

A Gravimeter or Urinometer, made small. 

Red and Blue Litmus-Paper. 

A Test-Tube. 

A Pipette. 

A Spirit-Lamp. 

A Blow-Pipe. 

Two or three Glass Slips. 

A Microscope or Object-Glass. 

Acetic Acid. 

Nitric Acid. 

A Solution of Potassa. 

A Solution of Hydrochloric Acid. 

Alcohol, Ammonia and Ether. 

In enumerating the foregoing conditions of the urine, and 
some of the changes produced by reagents, as also in the 
apparatus, we have drawn somewhat upon the already pub- 
lished works of Bird, Bowman, Griffith, etc., whose works 
would be found of most important service to the student as 
well as practitioner, as they have been a valuable guide to 
us in conducting our experiments, both in superficial as well 
as more complete investigations. And even where great ex- 
actness is required, as in cases of poison, etc., wherein the 
precise extent of the abnormal ingredient in the fluids is im- 
portant to the case, these works will be found of great value 
to the profession. 

The average proportion of the chief ingredients in the 
urine being reduced to a "standard," the quantity of water 
in a healthy specimen of that fluid, is placed at nine hun- 
dred and fifty-six parts in one thousand. 

An excess over that quantity will be known by its more 
limpid-water appearance, while the reverse or a deficiency in 
the proportionate quantity of water, will be recognized by 
the "heaviness of body" which it will exhibit, because of the 
undue proportion of organic matters or fixed salts it must 
contain. The optical properties even thus noticed, will 



TJrino-Pathology. 81 



many times determine whether the specimen be above or 
below the standard specific gravity. The application of the 
gravimeter, however, will determine the precise course and 
extent of such deviation from the healthy standard, and will 
thereby suggest important points for consideration. 

This excess of water in some diseases, as in hysteria, and 
some others, in which want of red globules is the character- 
istic, amounts to nine hundred and ninety-five parts in one 
thousand, while in some other diseases it has been known to 
be reduced to less than four hundred and eighty parts in 
one thousand, as in cholera, etc. The average quantity of 
urea contained in the standard of healthy urine being four- 
teen and five-tenths, an excess of that substance is charac- 
ized by the "body" or weight which it adds to the urine. 

Its specific gravity will be greatly increased. In some 
diseases wherein that substance reaches a very great excess, 
the urine has been known to contain more than thirty parts in 
one thousand. In these cases the uAie looks almost like a 
moderately-strong solution of saltpetre, with a little coloring 
matter added. It is considered to be one of the products of 
the destructive assimilation of the tissues of the body. ( See 
Chart, Fig. 1). 

The average quantity of uric acid contained in the stand- 
ard of healthy urine being four-tenths parts in one thousand, 
when in excess in that fluid, "it usually exhibits rather a 
higher color than the healthy secretion, either a deep amber 
or a reddish-brown." In some diseases, such as inflamma- 
tory fever, it amounts to two, or even three parts in one 
thousand of urine, in which case its sediment is formed in 
the bottom of the glass on cooling, of a decidedly red color. 
It indicates inflammatory diseases, sometimes eruptive, and in 
some cases calculous diseases. 

The average quantity of extractives contained in the stand- 
ard of healthy urine being fourteen parts in one thousand, an 
excess of these always gives to this secretion a higher color 
than natural. When the excess is very great, the urine be- 



82 Urino- Pathology. 



comes of a decidedly reddish color, and when cool sometimes 
deposits a quantity of brownish or even bluish-black sedi- 
ment. This occurs generally in dissolved states of the blood, 
as in the last stages of typhoid fever, measles, etc. This kind 
of sediment is readily soluble in alcohol, a test whereby^it may 
always be determined. 

The average quantity of mucus, in healthy urine, accord- 
ing to the " standard," being two-tenths parts in one thousand, 
an excess of that substance, while it may produce no change 
in the color, yet it is very readily detected by the deposi- 
tion of a very viscid, tenacious substance, consisting, accord- 
ing to Bowman, "chiefly of mucus mixed with epithelium, 
which, when agitated, does not mix again uniformly with the 
fluid, but coheres together in tenacious, ropy masses, entang- 
ling and retaining numerous bubbles of air." It is charac- 
teristic of inflammation of mucus membrane, bladder, ure- 
thra, vagina, etc., indicating, sometimes, gonorrhoea, leucor- 
rhoea, etc. 

The average quantity of ammonia given in the standard, 
being nine-tenths parts in one thousand of healthy urine, the 
secretion containing it in excess, " will most frequently be 
found high-colored, dense and turbid." It generally indi- 
cates idiopathic fevers, local inflammatory action, etc. 

The rest of the ingredients composing healthy urine, as per 
"standard," being the "fixed salts," the whole comprising 
fourteen parts in one thousand of urine, are principally to be 
detected by chemical tests or reagents, or by the use of the 
microscope. " In the examinations of urinary deposits," 6ays 
Bird, " the microscope will be found to afford the most val- 
uable and ready assistance, the single microscopic inspection 
of a deposit often rendering its true nature at once appa- 
rent." 

CJiloride of Sodium, when in excess in urine, is very readily 
determined by the evaporation of* a small quantity of the 
fluid containing it, on a slip of glass, when the salt will be 



Urino- Pathology. 83 



found "in crystals shaped like daggers or crosslets." (Bird.) 
(See Chart, Fig. 2). 

" The soluble phosphates," says Bird, "must be regarded as 
being derived directly from the food and from the blood, when 
in the act of being formed into muscle. The insoluble phos- 
phates forming part of the structure of the body derived orig- 
inally from the blood, are conveyed to the urine in the process 
of metamorphoses of tissue." Now, phosphorus enters largely 
into the composition of some of the structures of the body, 
especially in that of the brain and nervous system. In cer- 
tain diseases of the brain, there has been found an actual 
deposition of this nervous matter in the urine, showing that 
the brain even follows the same general rule of other organs, 
and contributes its substance in disease, to the urinary secre- 
tion, and that such may be detected therein. 

Oxalate of lime, urate of soda, and others of the "fixed 
salts" of the urine may be readily detected by chemical tests, 
or by microscopic exanination, for which, see Chart. 

The presence of the "fixed salts" generally may be ac- 
counted for in the urine, by their presence in the food, drink, 
etc., from which they enter the circulation, the insoluble or 
unassimilatcd portions being separated by the kidneys. An 
excess of any of these may prove a source of irritation or 
irregularity in some part of the animal economy and is there- 
fore worthy of notice ; a substance called hicdtein is found in 
the urine of pregnant women, and will demand attention ; a?, 
also, spermatazociy found in the urine of persons laboring 
under seminal diseases; other substances, as tonda\ vi- 
broines, etc., have all demanded attention, and will receive a 
notice in their respective places in this work. 



INFLAMMATORY FEVER. 



We come now to the practical part of our work, the appli- 
cation of our theory to particular cases in practice. And 
first, let me remind you again, that you will be much facili- 
tated in all your examinations, by obtaining the age of your 
patient when he is not present ; as by that you may be 
saved the trouble of testing the urine of very old persons, for 
worms, croup, or diseases peculiar to children alone, or of 
very young persons, for diseases peculiar to middle-life or old 
age. 

In the above disease, to-wit : inflammatory fever, we know 
that it generally seizes young persons, in the flower of 
their age, and when full of blood. But as inflammatory 
rheumatism is very nearly allied to it in point of general 
conditions, both of blood and urine, and as this latter dis- 
ease sometimes attacks the more aged, the necessity of keep- 
ing in view the age of the patient will be apparent. 

The chief local symptoms of inflammation are defined to 
be redness, heat, pain and sivelling. "The redness of an 
inflamed part is obviously due," says Williams "to the in- 
creased quantity of blood in the vessels. The heat is depend- 
ent on the increased flow of blood through the part, " and 
may be considered the representative of the amount of de- 
termination of blood." The swelling of an inflamed part is 
caused by the enlargement of the vessels, the consequence of 
the increased flow of blood to the part; while the pain is 
caused by the exaltation of sensibility in the nerves, and the 
tension or pressure arising from the swelling. The irrita- 
tion of inflammation thus produced, frequently extends itself 
to the whole body ; and this is called inflammatory fever. 

"Among the most important general effects of inflamma- 
tion," says Williams, " must be noticed the change in the 



Urino-Pathology. 8 5 



condition of the whole of the blood." An excess of fibrin 
exists in all true inflammatory diseases, especially those of 
a sthenic character ;" in some cases }/L. M. Andral and Gavar- 
ret found the proportion of fibrin in the blood, to be as high 
as twelve parts in one thousand, the average in health being 
three. Even when inflammation supervenes in the course 
of another disease, " there is always an augmentation in the 
quanty of fibrin in the blood." 

The red globules of the blood have also been found largely 
increased in some inflammatory diseases, especially those of a 
sthenic character also, rising in some instances to one hundred 
and eighty-five in one thousand, the "standard " in health be- 
ing one hundred and twenty-seven parts. 

" The most sensible influence," says Prof. Jones, " which 
inflammation exerts upon the blood, as determined by analysis, 
is manifested in the increase of its fibrin. This, it is said, 
is uniformly augmented in quantity during the progress of 
inflammation, commencing from the first establishment of 
this abnormal excitement, and diminishing as it declines." 
"These facts," he says, " are established by the very best au- 
thorities." 

Now, in view of this altered state of the blood in inflam- 
matory fever, as represented by the authorities herein quoted, 
the quantity of fibrin always rising above the average, and 
sometimes amounting to three hundred per cent, above the 
standard in health ; and in view of a corresponding increase 
of the red globules of the blood in every case of this kind 
of fever ; and knowing that the secretion of urine proceeds 
entirely from the blood, you will readily anticipate the char- 
acteristic indications to be found in that fluid under these 
circumstances. But let us sec what arc the facts in the 
case, and what has been observed by eminent medical au- 
thors on the subject. 

"In inflammatory affections," says Simon, "and in I 
diseases which are accompanied by that form o( fever which 
is termed sthenic or syuochal, the urine differs greatly in ita 



86 Urino-Patliology. 



properties from normal urine." He does not refer the prob- 
able cause of the changed condition of the blood in these 
diseases, to the diseased organ alone, but in part to the re- 
action which manifests itself throughout the vascular system. 
He says, "if the change in the constitution of the blood bears 
an accurate and inseparable relation to the fever, there can be 
no doubt that the change in the constitution of the urine 
must be in the relation to the same cause, for the urine is 
separated from the blood, and was previously an integral con- 
stituent of it, and because, farther, every alteration in the 
constitution of the blood, must involve corresponding changes 
in the secretions and excretions, and more especially in the 
urine. Since like effects follow like causes, and since in in- 
flammatory affections the vascular system similarly partici- 
pates in the disturbance, we may assume a priori, that 
similar changes will occur in the urine — a point confirmed by 
experience." 

The urine discharged during inflammations is generally 
termed febrile urine, but there is an objection to this term, 
here. Since the cause of the change in the urine will be 
found in the character of the morbid change going on in the 
system, and will be inflammatory or febrile, according to the 
character of the disease, whether it be synochal, idiopath- 
ic, etc. 

In order to take a correct view of the composition of the 
urine then, we must bear in mind the composition of the 
blood, and the reaction of the vascular system, and authors 
tell us that if in these inflammatory cases, much blood be 
abstracted, the quantity of fibrin in the blood is lessened and 
the urine becomes immediately changed, being clear, specifi- 
cally lighter, and the amount of urea also decreases — abso- 
lutely and relatively. 

. The following is given as some of the general character- 
istics of the urine in inflammatory affections, by Simon : 

" The urine is darker than usual, and is of a yellow, brown, 
or reddish-brown tint ; it has an acid reaction, and is gener- 



Urine-Pathology. 87 



ally of high specific gravity. With respect to its most im- 
portant constituents, the urea is either absolutely increased, 
or is at the ordinary physiological average. The uric acid is 
always absolutely increased, and so are the extractive mat- 
ters. The salts are always absolutely diminished, especially 
the chloride of sodium." 

Prof. Eberle says that "revolution in this form of fever 
is almost invariably attended by general and free urination, 
etc.," and that " a reddish or pale sediment in the urine is 
a never-failing concomitant in the crisis of this fever." 

Prof. Beach says that " at first the urine is very high- 
colored" etc., " and when terminating by revolution a never- 
failing concomitant is found in a reddish or pale sediment 
in the urine." 

" The more acute and fixed the inflammation," says Wil- 
liams, " and the smarter the fever, the more abundant is the 
deposit, and the more free is the patient 'from disease after- 
ward." 

" The lateritious sediment in the urine, which is constant 
on the decline of inflammatory fever, is a pretty certain 
symptom of its subsidence, or of the amelioration, at least, 
of the inflammation." 

This excessive deposit, on the subsidence of the inflamma- 
tion, indicates an increased exertion of the solid constituents 
of the urine, some of which had probably been delayed in 
their exit during the first febrile excitement, because of the 
scanty secretion of that fluid. 

During the first stages of the inflammatory excitement, 
" the urine is marked by a more bright and highly-colored 
appearance, together with a reddish-tinged floculi, which seems 
to have been wrung, as it were, from the excited organs," 
says Eberle. 

"That these are the excrementitious matters that had m0 
cumulated in the blood, when the skin was dry and hot and 
the natural secretions were diminished, as in the first s: 



88 JJrino-Paihology. 



of this fever, we can scarcely avoid to conclude," says Wil- 
liams. 

That these are the decayed tissues which are always tak- 
ing place in such cases, there can be no doubt, together with 
the particles that are in excess in the blood. 

The blood, in this disease, being characterized by an excess 
of fibrin, as also an excess of red globules, how natural that 
we should find in the excrementitious matters which proceed 
therefrom, a fluid not only of a u more highly-colored ap- 
pearance, but " tinged with a reddish floculi," the real fibrin 
itself, which has been wrung from the excited organs, im- 
parted to the blood, and separated therefrom by the kidneys. 

When the crisis has formed — when the great change has 
come over the patient, a great change seems to come over 
the urine also — " the pale-reddish sediment, the never-failing 
concomitant," etc. This sediment, however, true to the never- 
varying rule, is composed of the same substance as that be- 
fore, metamorphosed only ; together, perhaps, sometimes, with 
disintegrated parts from other tissues, as the chemical anal- 
yses of Bird and others have fully shown. 

These organic matters, red particles, floculi, sediment, etc., 
which have been in such excess in the blood, and carried out 
by the urine, are metamorphosed into uric acid, which chem- 
ical analysis and microscopic observation discovers to be in 
the urine in great excess, " and commensurate with which 
excess, will have been the activity or severity of the inflam- 
mation." " For, in all acute inflammatory disorders," says 
Bird, " a considerable increase in the quantity of uric acid 
will occur, and deposits of this substance, either free or com- 
bined, will appear in the urine," " generally amounting to 
more than double the average," says Becquerel. 

The urine then, in this disease, from the forming stage to 
the crisis, will be found bright and high-colored, amounting 
even to a cherry red, with a reddish-tinged floculi suspended 
in it, as may be observed by holding it in a clear glass ves- 



Urino-Pathology. 89 



sel before a light, the extent of color and amount of floculi 
varying with the extent of the disease. 

From the crisis to the completion of convalescence, it is 
found to deposit crystals of every shade and tint, the deeper 
the color and the more extensive the deposits, the more 
extensive it shows the disease to have been, or the more 
quickly complete convalescence will ensue. 

But should the patient continue to grow worse, until a dis- 
solution of the blood takes place, the urine will gradually 
become more and more heavily loaded with these deposits, 
and will become heavier in body and darker in color, even 
muddy-like, or almost a coffee-ground appearance, which is 
the evidence of approaching death. 

" When urine contains this acid in excess, it generally 
lets fall crystals on cooling ; and they are sometimes suffi- 
ciently large to allow their figure to be defined without the 
aid of the microscope. Every shade of tint, from the palest 
fawn-color to the deepest amber or orange-red, is to be found 
in the deposit ; the deeper the color of the urine, the darker 
the color of the sediments." ( Bird). 

It always reddens litmus-paper, and its specific gravity is 
above the average. When the urine is high-colored, the ad- 
dition of a few drops of. nitric acid will cause a deposition 
of an abundance of these crystals. 

If you wish to examine with the microscope, Dr. Bird has 
given the most convenient plan, which he describes thus : 

" Allow the urine to repose for a short time in a tall ves- 
sel, decant the greater portion, and pour a teaspoonful of the 
lowest turbid layer into a watch-glass ; gently warm it to dis- 
solve any urate of ammonia and to aid the deposition. Re- 
move the supernatant urine with a pipe! to, and replace it 
with a few drops of water, then place the watch-glass under 
the microscope and the crystals covered by the water will 
become most beautifully distinct. " 

We have been thus elaborate in our explanations of the 
condition of the blood in this disease, and the different char- 



90 Urino-Pathology. 



acters of the urine in the different stages, because it is the 
ruling one of a large class of disorders, some of the char- 
acteristics of which will be found throughout the whole list 
of inflammatory diseases. 

From the foregoing history of the condition of the blood, 
and the peculiar character of the urine in this disease, it 
is plain that the treatment which would be the most effect- 
ual, or at least of considerable aid, would be such remedies 
as operate in diminishing the red particles, and reducing 
the excess of the fibrin in the blood. 

Here lies the great practical value of our system : to arrive 
at the true cause of a departure from health, that the remo- 
val of that cause may be effected. The treatment which has 
been found most effectual in this disease, makes the correct- 
ness of our conclusions the more final. The various saline 
medicines, such as nitrate of potassa, and the alkalies, com- 
bined with vegetable acids, seem to have a good effect, by 
augmenting the elimination from the blood to the kidneys. 

"These," says Williams, "being more or less diuretic, by 
supplying an alkaline base, unite with the acids, formed in the 
blood, and facilitate the separation of the matters by the 
kidneys." 

Among inflammatory diseases, in which some of the gen- 
eral characteristics of the blood, mentioned under this head, 
will be found to exert a partial influence over the urine, in the 
manner here described, may be mentioned inflammation of the 
brain, lungs, heart, liver, stomach, bowels, kidneys and womb, 
also, acute rheumatism, etc. 

But in all these, each have their other distinguishing marks, 
whereby they are known one from the other, generally because 
of the additional change in the constituents of the blood, its 
corresponding change being exhibited in the urine. 

The urine, then, in the advancing stage of inflammatory 
fever, will be of specific gravity above the average ; it will 
redden litmus-paper; will be highly-colored, sometimes cherry- 
red ; and will contain a reddish-tinged floculi. 



Urino-Pathology. 9 1 



In the declining stage it will first deposit a pale-reddish 
sediment, becoming more highly colored, even to a deep orange- 
red ; finally, let fall an abundance of uric acid crystals. ( See 
Chart, Figs. 3 and 4). 

In the last stage it will be dark-colored, thick, heavy and 
muddy-like ; sometimes like coffee-grounds. 



INFLAMMATION OF THE BRAIN 



Erom analyses of the brain, made by different authors, it 
appears that the medulla oblongata and spinal cord contain 
the same constituents, a preponderance being given to the 
brain only, of phosphorus ; and that the amount of cerebral 
energy is proportioned to the relative amount of the phosphoric 
element in that organ. From the table of analyses of the 
brain of infants, youths, adults, aged persons and idiots, drawn 
by L'Heretier, from his own researches, the amount of phos- 
phorus in the brain of infants and idiots was scarcely appre- 
ciable, rising in youths, to a maximum in adults, and declining 
again in the aged. In the brain of a complete idiot there was 
not a trace of phosphorus to be found. 

"In inflammatory affections of the brain, and also in those 
of the spinal cord, especially in chronic cases," says Simon, 
"the kidneys and bladder sympathize to a high degree." 

The urine, in these cases, is either only slightly acid at first, 
if at all, is generally neutral, and, in a very short time, be- 
comes alkaline. 

"When first discharged, the urine is clear," says the same 
author, "generally of a bright yellow color, and possesses 
rather an unpleasant odor. If allowed to stand, a glistening 
pellicle often forms quickly on the surface, consisting partly of 
crystals of ammoniaco-magnesian phosphate, and partly of 
amorphous phosphate of lime, as may be seen by the micro- 
scope." After a time, the urine becomes turbid, and depos- 
its a sediment of earthy phosphates and mucus, and a strong 
ammoniacal odor may be given off, when, upon the addition of 
hydrochloric acid to the urine, a well-marked effervescence 
will be produced by the liberation of carbonic acid." 

A case is related in which a man, aged forty years, was 
brought into a hospital with a severe cerebral affection ; he 
soon sank into a state of deep coma, and the urine was emit- 



Urino-Pathology. 93 



ted involuntarily. It had an ammoniacal odor, an alkaline 
reaction, and soon deposited a sediment of mucus and earthy 
phosphates, and, upon the addition of nitric acid, a brisk effer- 
vescence took place. 

This characteristic of the urine is to be found in many cases 
of insanity, and sometimes in meningitis, and in encephalitis 
of children even. But "inflammatory affections of the brain 
and spinal cord are not the only diseases," says Simon, "in 
which carbonate of ammonia is formed in the urine, as we shall 
subsequently show that alkaline urine is frequently observed in 
diseases of the kidneys and bladder, and in nervous fevers." 
We will remind him, however, that even in these, the patho- 
logical condition of the brain may have much to do with it. 

The symptoms of inflammation, as mentioned in preceding 
pages — redness, heat, pain and swelling — would be those of 
the brain, in inflammation of that organ ; the consequence of 
an increased quantity of blood in, and flowing through the 
vessels, producing enlargement and consequent pressure upon 
that organ itself. Hence, the same conditions of blood as are 
presented in general inflammation, will be partially met with 
in this, together with the addition of a peculiar nervous sub- 
stance, the consequence of a chemical change in the substance 
of the brain, "consisting," says Prof. Buchanan, "of a disin- 
tegration of the nervous matter from that organ." 

Physiologists have considered the functions of the brain so 
dependent upon the momentum of the blood in its vessels, 
that, " where the neck is very long, and the brain far removed 
from the heart," says Burrows, "the faculties are more lim- 
ited and its functions less active, whereas, a short neck and 
approximation of the brain to the heart, usually coincides with 
cerebral energy." 

Now, as phosphorus enters more largely into the composi- 
tion of the brain and nervous system, but more especially 
the brain, than any other organ or part of the body, 
i he disintegration of that qjgan is going on by inflammatory 

action, these disintegrated particles are being taken up by the 



94 Urino- Pathology. 



blood, and conveyed into the urine, by which it is eliminated ; 
metamorphosed, however, into phosphoric acid and other phos- 
phates, perhaps. 

The urine, in the disease now under consideration, as a 
general rule, will be paler than natural, although marked with 
a reddish-tinged floculi or red particles of inflammation. Its 
specific gravity will be a little above the average, and con- 
stantly alkaline to test-paper. The deposit, which falls to the 
bottom, on repose, will be of a whitish, or sometimes of a red- 
dish-gray color. This consists of phosphates, and sometimes 
is exhibited in excess of phosphoric acid, amounting to as high 
as eight parts in one thousand of urine, two and two-tenths 
being the average. (See Chart, Fig. 7, also page 62). 

To test this deposit, by chemical action, you have but to add 
a little dilute hydrochloric acid to the specimen, and it will 
immediately dissolve it, leaving the urine more clear ; while 
liquor-ammonia or potassa produces no effect. 

When, therefore, you find the urine paler than natural, al- 
though it may be somewhat hazy, and a little tinged with red, 
specific gravity a little above the average, alkaline, deposit of 
the above-mentioned kind and color, having tested it chem- 
ically, and viewed the deposit under the microscope, and found 
it to correspond in appearance to the " prepared specimen" or 
the figure in the Chart, you will be enabled to pronounce at 
once upon the nature of the disease. These characteristics of 
the urine if not, when taken separately, certainly when com- 
bined, will enable one to discover not only the brain to be the 
seat of inflammation, but to partially estimate the extent also 
of the organic mischief going on at the time, by the amount 
of disintegrated particles imparted to that fluid, from the 
metamorphosed substance of that organ. 

"The occurrence of these phosphates in the urine," says 
Bird, "must be regarded as of serious importance, always 
indicating the existence of important functional, and too fre- 
quently, of even organic mischief." 



Urino-Pathology. 95 



If this disease becomes of a dangerous and aggravated 
character, and the depressed state of the cerebral and nervous 
energy becomes extreme, "an extensive elimination of urea 
will be discovered in the urine," a fact necessary to be borne 
in mind in the examinations in the last stage of this dis- 
ease. 

Prof. Buchanan says of the brain, that the chemical changes 
of its substance consists of the disintegration of the nervous 
matter, and that these changes are accompanied by corres- 
ponding changes in the secretions, and that the kidneys, of all 
organs, appear to sustain the most intimate relations thereto. 

In the advancing stage, the specific gravity of the urine will 
be above the healthy standard; it will be alkaline to test-paper; 
and paler than natural, but hazy, and tinged with red. 

In the declining stage, the urine will be heavier, and the 
deposits whitish or reddish-tinged, and sometimes grayish sedi- 
ment, and will have an excess of phosphoric acid. 

In the last stage, there will be deposits of urea. 

The indications of cure are : 

1st. To equalize the circulation by sinapisms and pediluvia. 
with quickly-evaporating lotions to the head, as ether, alcohol, 
and sometimes warm water. 

2d. Moderate the circulation, to remove the tension, by 
sedatives, such as gelseminum, veratrum, viride, etc. 

3d. Remove the offending cause from the blood by diuretics 
of the vegetable character, as uva ursi, digitalis, buclm, etc., 
all three of which indications may be conducted at the same 
time. 



INFLAMMATION OF THE EAR. 



This is a peculiarly painful disease, and one the character of 
which is not always so readily determined without the closest 
scrutiny. Men have been treated for inflammation of the brain, 
who merely labored under inflammation of the ear, and upon 
the other hand patients have frequently been treated for "nerv- 
ous otalgia" when all the pain and dangers of true inflamma- 
tion existed, for it must be remembered that the sense of hear- 
ing is not only many times destroyed by neglect or improper 
treatment of deafness, but that extension of the inflammation 
to other parts : the bone, membranes of brain, encephalon etc., 
may prove dangerous to life. 

It is in determining between '-nervous otalgia," a neuralgic 
affection and true inflammation of the ear, that the urinary se- 
cretion becomes available, and is, more than all the other signs, 
to be depended on; the difference in the general characters of 
the urine of inflammation and of nervous urine, being the 
distinguishing marks. 

A case of the above disease came under our own observation 
a short time ago, the inflammatory action of which was only to 
be correctly determined by the appearance and quality of the 
urine, the sympathetic action of the nervous system having 
almost completely masked its true nature. The great nervous 
irritability of the patient led the attending physician astray, nor 
did he discover the mistake until his attention was directed to 
the continually high-colored and inflammatory appearance of 
the urine. 

So intimately connected with disease is the urinary secre- 
tion, that even, in " severe dysuria," says "Wilde, urine has 
been discharged from the ears." The urine in otitis is always 
scanty and high-colored, bearing all the general marks of in- 
flammation, "and toward the termination of the acute symp- 



TJrino-Pathology. 97 

toms, deposits a copious pinkish sediment." (Win. R. Wilde, 
on Diseases of the Ear). 

The above-quoted opinions correspond with our own expe- 
rience practically, having suffered the disease, as well as ex- 
perimentally in the examination of patients. 

We were suffering violently with otitis, the consequence of a 
cold, bleak ride along the bank of a river, with the piercing 
wind howling around our head, until our ears were well- 
nigh frozen. The inflammation being violent, we suffered in- 
tense pain for some time and passed several restless days and 
sleepless nights without abatement, yet it was only "ear-ache," 
and our friends thought it was "nervousness," which was not at 
all flattering to our character nor agreeable to our own opinion — 
more especially as we had observed the well-makred charac- 
teristics of inflammation in the urine. 

In a little while longer this opinion was fully confirmed by 
the termination of the inflammatory action in suppuration, and 
purulent discharge from both ears, and a subsidence of the 
pain, as also the irritability of the nervous system. 

The character of the urine, whether inflammatory or nervous, 
is always too well marked to deceive the merest tyro who 
will observe it. 



INFLAMMATION OF THE LUNGS. 



The blood, on exposure to the air in the lungs, is seen 
to change from purple to florid. During respiration the 
air exhaled contains less oxygen, and more carbonic acid 
than that inhaled ; the blood becoming so far chemically 
changed that it will now contain more oygen and less car- 
bonic acid. The production of this chemical change seems 
to be one of the principal offices the lungs have to 'perform. 

Of all excretions, that of carbonic acid seems the most 
essential to the continuance of life, and any sudden interrup- 
tion to its progress proves immediately fatal. We have many 
opportunities of recognizing the influence of carbonic acid on 
animal life as that of a poison, positively ; and we can trace 
all degrees of this agency from the inconvenience of breath- 
ing the ill-ventilated atmosphere of a close room, to the rapid 
extinction of life by inhalation of the vapors of burning char- 
coal. 

Whenever the extent of respiratory surface is diminished 
by any organic disease of the lungs, or the access of fresh 
air through them is obstructed, defective exhalation of car- 
bonic acid attends, and its accumulation in the bood results. 

" The most fruitful source of inflammation," says Calkins, 
" is a depraved state of the blood ; and owing to some chem- 
ical or other affinity on the part of different ingredients in 
it, for different tissues or organs, the localities of the inflam- 
mation created are varied according to the nature of the 
causes." 

In acute inflammation of the lungs, the blood soon be- 
comes surcharged with carbonic acid, because of its non- 
elimination, the swelling and consequent pressure in these 
organs preventing that freedom of action necessary to the 
full performance of the offices expressly devolved on them. 



TJrino-Pathology. 99 



The painful stitches which cause the patient to cry out in 
distress in this disease, arises, in part, from the irritating in- 
fluence of this carbonic acid, and the increased volume of 
blood to the organ, or its consequent tension. 

The substance of the lungs tremselves, chemically consid- 
ered, contains a greater proportion of carbon than that of 
any other part of the human system ; hence, not only does 
the imperfect elimination of carbonic acid from the blood 
become a source of disease, by its retention in the circula- 
tion, but when a disintegration of the substance of the lungs 
takes place, and these metamorphosed particles are taken up 
by the blood, an additional source of excitement is mani- 
fested therein. 

Now this double source of disease, as it were, together 
with the extreme delicacy of the tissues of these organs, and 
the constant requirement of labor devolving upon them, is 
the main reason that simple inflammation of the lungs is so 
prone to run into confirmed consumption, or chronic disor- 
ganization of these tissues. 

The blood, in inflammation of the lungs, usually exhibits 
the general character of phlogosis, more decidedly than in 
other inflammatory diseases. The clot is said to be rather 
below the ordinary size, very consistent, and does not break 
down for a considerable time ; its surface is covered with a 
huffy coat, and is more or less cupped ; the serum is of a 
pale-yellow color, and the quantity of solid constituents is 
usually less than in healthy blood. The maximum of fibrin 
is said to be much larger than is ever discovered in inflamed 
blood, while the hemato-globulin is very far below the amount 
in healthy blood. 

"The urine in pneumonia," Bays Simon, "is subject to 
considerable variations, dependent upon the extent of the d ; s- 
ease, and the degree of inflammation. In severe inflamma- 
tions the urine is very dark, of high Bpecifio gravity, and 
frequently Bedimentary, especially at critical periods and 
during the fever." 



100 Urino-Pathology. 



Becquerel, hoAvever, once found that the urine deposited a 
sediment on the day when the fever ceased. He also found 
the urine to remain acid during the whole period of inflam- 
mation, as also, during the period of convalescence. The 
small quantity of solid constituents in the blood in this dis- 
ease, coincides with the loaded state of the urine. 

The urine, in this disease, is "scanty and high-colored," 
most authors contenting themselves with this stereotyped 
assertion alone, but other and more definite characters are 
certain to be observed in this stage of that dangerous dis- 
ease, and difficult one to cure. 

The color of the urine will be found of a brighter red than 
natural, not brownish nor dingy, but bright, light crimson- 
tinged or cherry-reddish color ; and in the forming stage 
even, it will always be marked by the bubbles of carbonic 
acid, commonly called a "bead," which hold for some con- 
siderable time therein, if the vessel containing the urine be 
kept closed. 

Dr. G. Bird, on describing a certain kind of deposit in the 
urine, says that "it is so constantly an attendant on the 
slightest interference with the cutaneous transpiration, that a 
common cold is popularly diagnosticated whenever this state 
of things exist ;" and we think that we may here venture the 
assertion that this "bead" is universally present on every 
accession of what is termed " taking cold," even though it 
be during the progress of other diseases. 

The specific gravity of the urine in this disease, is always 
above the average in health, being loaded as it is with mat- 
ters, the product of non-assimilation of food, together with 
the disintegrated particles from the inflamed organs. 

By the addition of a few drops of nitric acid to half an 
ounce of a recent specimen of the urine, a thick whitish co- 
agulum, or collection of a light, fine down-like substance, 
will form in a table across the middle of the glass, leaving 
the upper and lower portions more clear. This distinct table, 
however, is more or less heavy, and sooner or later extends 



Urino-Pathology. 101 



to the whole, according to the quantity of said substance, 
which amount is the measure to the extent of the inflamma- 
tion. When this fine, white, down-like substance extends to 
the whole of the urine in the glass, it is rendered quite opake, 
or nearly so, and upon farther repose it deposits the same, 
transformed into mixed phosphates and other amorphous sub- 
stances. 

The urine in this disease is always acid to test-paper, there- 
fore, when you find it containing the bright-reddish tinge of 
inflammation also, carrying a "bead" representing bubbles of- 
carbonic acid, conglomeration of substances forming a table 
midway across the vessel, on the addition of nitric acid, and 
finally settling at the bottom, after first extending to the whole 
of the urine in the glass, and exhibiting under the microscope 
amorphous substances, or mixed phosphates, of lime, soda mag- 
nesia, etc., with perhaps traces of mucus or albumen; inflam- 
mation of the lungs may be confidently expressed and decided 
upon. 

If this substance, which is thus loading down the urine, as it 
were, should happily be carried off" with sufficient rapidity at 
the onset of the disease to relieve the lungs of the tension , 
and the blood of its overload of substances, a favorable prog- 
nosis may soon be made. This is best done by diuretic salts, 
in combination with diaphoretic teas and other medicines that 
increase the cutaneous transpiration, also; for by this, as well 
as the urinary secretion, may the office of the lungs be fulfilled 
for a time. In connection with these counter-irritants over t he 
region of the lungs, sinapisms, etc., will be of material service, 
in the first stage particularly, in removing the swelling and 
tension thereof. 

After the acute inflammatory action is removed a more 
tonic and nutrient medication may be profitably employed, 
say, hydrastine, iron, wine, etc., for the supply of the wear and 
tear, the blood and system has undergone, 

But, should the Functions of the depurative organs or kid- 
neys be inadequate to the task, and the transpiratory functions 



102 Urino-Pathology. 



render no assistance to the lungs, in this critical moment, 
the substance or tissues of these organs themselves are likely 
to give way or yield to the overwhelming power, when the 
more-to-be-dreaded disease, consumption, will take the sway. 

In such cases the specific gravity of the urine is generally 
above the average: it is acid to test-paper: its color-bright- 
red, or crimson-tinged; presents carbonic-acid bubbles, or 
"beads" on the top; a down-like table, forms in the. center, 
on adding nitric acid, which becomes opake on further re- 
pose ; and it deposits, amorphous, mixed phosphates, etc. 

With these characteristics presented in a specimen of urine, 
inflammation of the lungs may be safely set down as the disease. 
No mistake will ever occur, if the "signs" are properly un- 
derstood. 



INFLAMMATION OF THE HEART 



In this disease, if there is no other derangement of the 
human system in connection, the condition of the blood will 
be but little altered from the natural, and consequently there 
will be but a slight change or alteration in the appearance 
or quality of the urinary secretion ; hence you may be the 
more readily deceived in this affection, and more sadly dis- 
appointed, than in any other disease. 

Failing to discover much difference of appearance, from 
natural healthy urine, or to detect any material abnormality 
in quantity or quality, or any great degree of excess or de- 
ficiency of any of the chief constituents of the urine of 
health, from your inspection of that fluid, you might readily, 
and would be liable to regard your patient as being very 
little, if at all, afflicted; when, in fact, there would be very 
serious danger to be apprehended, the patient feeling all the 
symptoms of inflammation of a most vital organ. 

Although we have said the blood itself is very little altered 
in its general properties in this disease, still, there is enough 
change therein, to make the impression upon the urinary se- 
cretion sufficiently visible, when the character of that change 
is properly understood. 

The heart being the propelling power of the blood, does 
not prevent it from receiving impressions from external causes, 
the same as other organs, it being subject to the same laws. 
and dependent upon the same source (the blood) for its 
nourishment, and for the removal of its decayed tissues, 
must rely upon the same channels of exit. The color of 
the substance of the heart itself is unlike that of any other 
organ or tissue of the body, being rather of a light mahogany- 
brown, and an excess of particles from this part, would, 
after the disintegrating process o( inflammation, be imparted 



104 Urino-Pathology. 



to the urine. This fluid therefore, would not only be light- 
ened in color by the inflammatory action, which would give 
it a reddish tinge, but the peculiar light mahogany-brown 
color of the disintegrated particles which had been wrung 
from the substance of the heart itself, would be added 
thereto. 

Now, if you can but imagine the color such a combination 
would form, you will have some conception of the appear- 
ance of the urine in this disease. We can only describe it as 
being more of a mahogany-brown color than the urine of 
any other disease, and to maintain the same appearance 
without change when exposed to the air, longer; and to be 
less easily affected by chemical tests, than is morbid urine 
generally. 

Lecanu analyzed the blood of three men and five women 
who were suffering from this disease. Unfortunately he 
made no observations on the physical characters of the 
blood, and the quantity of fibrin was not ascertained; but 
the proportion of solid residue, and especially of the corpus- 
cles, indicated a high degree of inflammatory action, and we 
have no doubt there would have been found an excess of 
the fibrinous element. The most remarkable feature seemed 
to be the extreme diminution of albumen in the blood. 

Dr. Simon examined the urine in a case of very acute 
pericarditis. It was clear, of a deep fiery-red color, had an 
acid reaction, was of high specific gravity, and on being 
heated gave indications of the presence of albumen. 

Zimmerman found fibrin in the urine of a patient with 
"endo-carditis of the right ventricle at the period of the com- 
mencement of hypertrophy." 

These are about the whole of the different variations from 
healthy urine, or about all the characters we can enumerate 
as being peculiar to this disease alone, and they require to 
be scrutinized closely to be detected. 



Urino-Pathology. 1 5 



This disease soon involves other organs, when other 
characters will be given to the urine. 

Treatment : Purgatives, sedatives, diuretics, with counter- 
irritants over the region of the heart, are the principal indica- 
tions of cure. 



INFLAMMATION OF THE LIVER. 



In inflammation of this organ, we need hardly say that the 
usual symptoms of general inflammation, to-wit: "the tinge of 
red particles," etc., will be partially presented in the urine, 
but proceed to give the other indications manifested in that 
fluid. 

First, however, let us see what we should expect in this 
disease. The liver is not only different in color and chemical 
composition from the brain, heart, lungs, or any other organ of 
the body, but its office in the animal economy is also different 
and peculiar. It is a depurating organ; its office being to free 
the blood, as it were, of a great portion of its foulness; this 
only gives it a more primary importance in its connection 
with many other diseases. 

It is of a dull-red, or brownish color, and is composed 
principally of glandular substance, and is designed for the 
manufacture or secretion of bile. 

The natural color of the liver being a dull-red, in inflam- 
mation, this color would therefore be increased; hence, any 
disintegrated particles therefrom would be highly or heavily 
colored indeed. 

While the bulk of this organ would be enlarged by the 
inflammation, and its healthy secretion of bile interfered with or 
suspended, as it would be, some of the elements at least of this 
suspended secretion (bile) would be retained or find their way 
into the blood ; and it is quite evident that such is the case, 
from the yellow color and jaundiced hue of the skin, eyes, 
and secretions in every case of biliary derangement. Hence, 
"in the elimination of that fluid, which is secreted from the 
blood," during this excitement, and which it is destined to 
rid the blood of this surplus or unhealthy matter, as also to 
remove the decayed tissues of the liver itself, with which the 



Urino-Pathology. 107 



blood has become burdened during this inflammatory action ; 
in view of the office this eliminatory fluid is required to 
perform, have we not good reason to expect to find it not 
only altered in its general properties, and changed from 
its natural appearance, but even partaking of the very 
qualities thus imparted to it by these circumstances ? Most 
certainly we have ; and, also, the ratio of difference between 
the average proportion of the chief constituents of a stand- 
ard quality of healthy urine, and the urine thus discharged, 
to be the ratio of the disease, or the extent of the deviation 
from health. 

In accordance with the philosophy above, in inflammation 
of the liver, true to the facts therein stated, the urine is 
discovered to be more highly or dark-colored, sometimes of 
a deep-saffron, or even a deep-green color, and in extreme 
cases amounting to a dark-brown color, according to the ex- 
tent or severity of the inflammation. 

Dr. Beach says, " the urine is scanty and high-colored." 

Hooper says, "the urine is small in quantity, and some- 
times saffron-colored, and if the disease continues for some 
days, it becomes very dark-colored, and deposits a red sand 
and a ropy mucus." 

Dr. Newton says, " there is a jaundiced discoloration of the 
eyes, skin and urine." 

In regard to the constituents of the blood, in hepatitis, it 
seems there has not been very accurate analyses made, but 
enough is known to satisfy us that the blood is not only far 
from being normal, but that the abnormality of the constitu- 
ents arc plainly visible. 

"Nassc has occasionally seen it so highly colored with bili- 
phein as immediately to tinge paper on being dipped in it." 
And Laucr has observed that a yellow-colored sediment ifl 
deposited by the serum upon the buffy coat, during this dis- 
ease. 

According to Coindet, "the urine in Inflammation of the 
liver, instead of urea, contains a substance resembling bilin at 



108 Urino-Pathohgy. 



least." In the analyzation of the urine of a man who was 
suffering from acute hepatitis, as conducted by Simon, the 
urine was scanty, had an acid reaction, was of a dark, red- 
dish-brown color ; on the addition of nitric acid, the brown 
color of the uriue changed into a decided green, and con- 
tained biliphein. 

Becquerel analyzed the urine of a man attacked with icte- 
rus ; the urine was very bilious, and deposited a yellowish 
sediment of uric acid. 

Schonlein states that the urine, in hepatitis, is of a dark-red 
color, approaching a brown ; that it usually contains biliphein, 
and that at the crisis, a rose-colored precipitate is sometimes 
formed. 

Dr. Shearman says, "when the functions of the liver are 
deranged, and when bile is circulating in the system, the urine 
is very brown, and easily shows bile by the proper tests. 

But why multiply testimony to prove an admitted fact? 
From the foregoing explanations, and descriptions of the urine 
in the inflammation in question, there would seem to be no dif- 
ficulty in determining the nature of a case by a mere in- 
spection of the urinary secretion alone. 

The dark, reddish-brown, the deep saffron, the dark-green, 
or in severe cases, the very dark-brown colors, together with 
the red sand-like deposits, and the ropy mucus, according to 
the severity of the disease, will at once suggest to the mind 
the probable substance with which this fluid is loaded. If 
bile be suspected, as it most likely will be, the simple test 
of nitric acid, added to the same quantity of urine, on a 
white plate, the rapidly-ending play of colors, as before sug- 
gested, will be seen, as the acid mixes with the urine. 

This disease, if not fully removed, is apt to leave such 
traces after convalescence, as lead to a chronic affection of 
that organ, which see. 

Treatment : Small doses of podophyllin in combination with 
two or three-grain doses of leptandrin, Dover's powder, dan- 
delion-root tea, with irritating plaster over the right side. 



INFLAMMATION OF STOMACH. 



As the stomach is the receptacle of all the nutriment that 
is required to keep up the wear and tear of the whole system, 
and as it is from this organ the blood receives the pabulum, 
which it so readily distributes to each part, according to 
its wants: so also, is it the store-house from which is received 
into the circulation, much of the deleterious substance that con- 
taminates the body. 

How quickly some substances enter the blood after being 
received into the stomach, is evidenced in cases of poisoning. 
Dr. Kramer discovered prussic acid in the blood of an animal 
which died from it in thirty-six seconds. Arsenic may be 
detected, both in the blood and urine, in a very short time 
after it is taken into the stomach. Orfila has found that 
arsenic most readily passes off during life by the urine. 

In inflammation of the stomach, from whatever cause how- 
ever, its regular functions of preparing nutriment for the 
blood, is interfered with, or entirely suspended sometimes, 
which interference or suspension will very suddenly change 
the character and composition of the blood, and therefore, 
morbidly affect the urine, according to the disorder of the 
digestive organs. 

"Owing to the morbid state of the stomach," says Rennet. 
" the chyle is imperfectly elaborated, unfitted for the purposes 
of assimilation and nutrition, and on its being absorbed hx 
the lymphatics and passing into the blood, the kidneys 
eliminate and throw out the effete matter in the shape o( 
urate of ammonia, triple 4 phosphates, or oxalate of lime, etc." 
tk The stale o\' the urine," savs the same author, "ifl often 
;i much more delieate lest of tho integrity of the functions 
of digestion, under all rireumstanees, than the other symp- 
toms which we have enumerated." "Indeed we are BUrprised," 



110 Urine-Pathology. 



continues he, "that so little attention should have hitherto 
been paid to this secretion" in disease of the stomach. The 
urine in this disease is highly colored, amounting, in some 
cases, to a deep or dark-brown, and if not turbid when first 
passed, will soon become so. 

After it becomes turbid it soon throws down a dark-brown 
or dirty pink-colored sediment, which, upon examination, will 
be found to be urate of ammonia. If the disease progresses, 
phosphate of lime, or oxalate of lime will be found in the 
urine, which Bennet says, " when present, it often forms an 
iridescent film on the surface, like that which is seen on lime- 
water when exposed to air." 

We have often noticed this last-mentioned appearance in the 
urine of inflammation of the stomach and bowels, as also 
epithelial scales, which are ever present in both these diseases. 
" The exfoliation of epithelial scales is sometimes so great, 
says Bennet, " that they are plainly visible to the naked eye," 
and so constant is their presence in urine from inflammation 
of the stomach and bowels, that we have frequently correctly 
diagnosed these diseases from this appearance alone." There 
is a slight difference only between these scales from the 
stomach, and such as are cast off during inflammation of 
the bowels; the former being flat and but little curled or 
curved. When the naked eye is unable to detect the difference.. 
the microscope should be applied to. 

The urine is always of high specific gravity alkaline to 
test-paper. It deposits urate of ammonia, triple phospates 
or oxalate of lime, and epithelial scales, bran-like and flat. 

Treatment: Beach's Neutralizing Cordial, and mustard plas- 
ter over the region of stomach, and mucilaginous drinks. 

This disease if not properly cured, or fully removed by a 
correct course of medication, is likely, after the most urgent 
symptoms have abated, to terminate in dyspepsia, which see. 



INFLAMMATION OF THE BOWELS. 



In this disease the internal coat of the intestines is the 
part affected, and as this is but a continuation of the same 
mucus surface as the stomach, the difference in the urinary 
secretion, from that described in the preceding disease, can 
not be very great. 

The primary operations of digestion, however, is not so 
fully interfered with in this disease as in inflammation of the 
stomach ; therefore, a measurable difference, in point of the 
depurating process, must occur. 

It is a well-known fact that in inflammation of the bowels, 
dysentery, etc., although there is great thirst, the patient con- 
tinually calling for water, there seems to be a very scanty 
supply of urine ; in fact, an almost entire suspension of the 
urinary secretion takes place in every violent case. Indeed, 
when the symptoms run very high, as in cholera, there is a 
total suspension of that function, and a return of the urinary 
discharge only when the patient begins to convalesce. So 
universally is this the case, that a favorable prognosis may 
always be given in these diseases, when there has been a 
return of a plentiful flow of urine, especially if it be of a 
peculiar sedimentary kind containing the characteristics of epi- 
thelial scales. 

The urine in this disease, will be characterized by the gen- 
eral high color and reddish-tinged floculi of inflammation, 
bordering, sometimes, on the dark-brown, and before it be- 
comes turbid a large quantity of somewhat-curled, bran-like 
epithelial scales, each having a convex and concave side, may 
be readily seen thickly interspersed through the whole. These, 
to be seen with the naked eye, must be examined shortly 
after the urine is first voided, as after it becomes turbid they 
are perceptible only by the microscope, and the urine in this 
disease becomes turbid in a very short time, because of its 



112 Urino-Pathology. 



highly-concentrated character, for be it remembered that it is 
always highly concentrated in this affection. 

The specific gravity of the urine in this disease, will be 
above the average ; its color will be very high, even to dark- 
brown, and it will contain curled epithelial scales in large 
quantities, discoverable by the naked eye before the . urine 
becomes turbid, after which it deposits urate of ammonia, 
triple phosphates or oxalate of lime, respectively, according 
to the grade of the disease. 

If urate of ammonia is deposited, the addition of liquor- 
ammonia or liquor-potassa will dissolve it. 

If the phosphates, an iridescent film of crystals will form 
on the surface of the urine. If oxalate of lime, it will dis- 
solve in nitric acid without effervescing. 

Whatever grade of inflammation the deposits may be char- 
acteristic of, the microscopic appearance will assist in deter- 
mining. 

According to Schonlein, in purely inflammatory diarrhoea, 
the urine is of a fiery-red color, causing scalding in the ure- 
thra, and forms, at the crisis, a crystalline sediment of uric 
acid. It may be that this scalding of the urine has some- 
thing to do with the formation of the epithelial scales which 
are so universally present in these cases. 

" In catarrhal diarrhoea, the urine is rather dark, and be- 
comes more so in the evening ; at the crisis, a mucus sedi- 
ment is deposited. In bilious dysentery, the urine is of a 
dark-red color, tending to a brown ; during the crisis it 
yields a fawn-colored precipitate." 

Finally, in typhus dysentery, the urine is dark, turbid, 
and fetid. During the crisis, it forms no precipitate, but 
becomes clear and loses its smell." 

So you see by authors, that even the character of enteric 
diseases, the distinguishing marks which make up their differ- 
ence, whether catarrhal, bilious, or typhoid, etc., may be read- 
ily determined by the character of the urine, and hence, by 
a knowledge of this secretion in disease, the practitioner will 



Urino-Pathology, 113 



be much aided in his diagnosis, and consequently, more suc- 
cessful in the duties of his profession. 

Treatment : Of all the remedies in use, the one most uni- 
versally depended on, and that gives most satisfaction to 
Eclectics, is the Neutralizing Cordial, and Sudorific Drops of 
Dr. Beach ; small and oft-repeated doses of podophyllin in 
combination with three or four-grain doses of Diaphoretic 
Powder, has been of much service to our patients. Spear- 
mint, flaxseed, or some diuretic tea, should be drank, and 
sinapisms placed over the region of pain. 



INFLAMMATION OF KIDNEYS 



This disease, like other inflammatory complaints, is charac- 
terized by redness, heat, pain, and swelling of the organs 
involved. And when we take into consideration the position 
of the kidneys in the human system, the function they have to 
perform in preserving the balance of power between the de- 
purating organs, whereby the superfluous matters are removed 
from the whole of the blood, we can not but regard an inflam- 
mation of these organs as fraught with the greatest danger to 
the animal economy, and liable to produce, suddenly, fatal 
consequences. 

Dr. Beach says : " That diseases are carried off by a copious 
discharge of urine, every physician knows.'' 

Prof. Eberle says: "At present this excretion is unques- 
tionably too much neglected ; by an attention to it, we will 
often be greatly aided in our judgment of the nature of dis- 
eases." It is of primary importance in all diseases in 
which the urine is concerned, and whatever may be the 
disease, seldom fails in furnishing us with a clue to the princi- 
ples upon which it is to be treated." 

Dr. Simon says : "From the physical and chemical state of 
the urine, the attentive, observing physician may obtain a 
great quantity of information for ascertaining and establish- 
ing a diagnosis." 

The kidneys are not only charged with the important office 
of removing from the blood the excess of nitrogen that may 
be found in the circulation, which can not be got rid of by any 
other source, but are also charged with the office of removing 
a great variety of other substances, whether normal or ab- 
normal to the blood, that may enter the circulation or have 
been retained therein. 



Urino-Pathology. 115 



When, therefore, her functions are interfered "with by in- 
flammatory action, not only the highly poisonous nitrogen will 
be thrown in upon the blood, which if not speedily removed, 
will soon produce death, but the various other substances 
thus retained will also produce serious derangements of the 
system. 

The urine, in this disease, will be scanty and highly col- 
ored, at first of a flaming or fiery-red, but soon changes, 
as the disease progresses, to a dark-brown, is very highly 
concentrated, and has a strong, pungent, disagreeable odor. 

All the fluids of the body become contaminated in this dis- 
ease, and consequently the urine soon becomes putrefactive 
and takes on a dark, dirty-red appearance, "becomes semi- 
solid, when cold,'' says" Simon, "and of a dark color not 
unlike a mass of black-currant jelly." 

In speaking of nephritis arthritica, Schonlein describes the 
urine as being of a fiery-red color, very acid, and soon after 
emission depositing glistening crystals of uric acid, in some in- 
stances the sediment occupying half the volume of the urine. 
If the disease terminates in convalescence, at the commence- 
ment of recovery the urine is secreted more copiously, and 
forms a creamy, and often a brown sediment which afterward 
separates itself into floculent mucus. 

The very heavy deposits made in the urine in this disease, 
are composed principally of nitrate of urea, which is in excess. 
The average proportion of that constituent in healthy urine 
is about fourteen and one-half parts in one thousand, and any 
excess over that proportion is disease, the extent of the excess, 
as in most cases, measures the extent or severity of the dis- 
ease also. 

When an excess of nitrate of uvea exists, add half the same 
quantity of nitric acid, place the vessel in a cool place, and 
crystalization will immediately commence on the edges of the 



116 Urine-Pathology. 



fluid, and soon be thrown down to the bottom of the vessel. 
They may be readily examined with the microscope, appearing 
as in Chart, Fig. 1. 

Treatment : Mucilaginous and other diuretics, marsh-mallows- 
root, cleavers, or uva ursi tea, cream-tartar physic, aconite, 
irisin, leptandrin, etc. 



INFLAMMATION OF THE WOMB. 



The womb is a spongy body, composed of arteries, veins, 
lymphatics, nerves and muscular fibre. Inflammatinn of this 
organ seldom occurs, excepting after child-birth or delivery, 
when there are many concomitant circumstances in connection 
therewith, such as suppression of lochia, secretion of milk, etc., 
which give additional characteristics to the disease. 

Simultaneous with this inflammation and these suppressions, 
the blood becomes loaded with abnormal substances, the result 
of these circumstances, for the removal of which, the system 
is indebted to the^urinary secretion. 

Dr. Bennet says that a in this disease the urine may be 
turbid when first passed, and as it cools the turbid matters 
collect in high-colored flaky clouds, which after remaining a 
short time in a state of suspension, depose in the bottom of 
the glass. If not turbid at first, it may become so on cool- 
ing. The uriue then is generally of a dark-brown color, and 
the sediment that forms is also of a very dark-brown, or a 
dirty-pink hue. These sediments are generally constituted of 
amorphous urate of ammonia, but may contain crystals of oxa- 
late or phosphate of lime. 

The epithelial scales in this disease, as also in that of in- 
flammation of the stomach and bowels, wc know is attributed by 
some to be entirely from vesical irritation of the urinary 
organs, but it matters not to us from what source, if always 
present in certain diseases, it serves our purpose as a guide. 

If, then, the urine contains not only the epithelial scales. 
somewhat similar to those in inflammation of the stomach or 
bowels, but milk-globules as secreted from the blood, and also 
the dirty-reddish, or pink-hue lochial matters, and in severe 
cases, where the inflammation has run high, pus-globules, as 



118 VrinO'Paifiology. 



Tvill sometimes appear, we will have no hesitation in pronounc- 
ing the case inflammation of the womb. 

The urine is always high colored, or deep and dark-colored, 
and morbidly loaded with the salts above mentioned, as well as 
the dirty matters. 

If the inflammation progresses, the usual dark, muddy-like 
appearance of the urine of putrefaction will be presented in 
connection with the above. 

If it is desirable to test the qualities of the deposits, the 
usual tests for urate of ammonia, oxalate of lime, phosphate of 
lime, milk, pus, or blood, may be conducted through their sev- 
eral operations with advantage, and the microscope brought to 
the aid of diagnosis. 

Treatment: Sweet spirits of nitre in water, althea-root tea, 
and tinct. macrotys through the day, with small doses of podo- 
phyllum and Dovers powder at night, with rest, quietude, light 
diet, and wet-bandage around lower bowels. 



INFLAMMATION OF BLADDER. 



Cystitis may arise from an acrid secretion of urine, a 
predominance of uric acid, from calculi, or whatever inter- 
rupts the balance of the circulation. 

Tenesmus, pains in the loins, difficult urination, bearing-down 
efforts, violent pain, nervous irritability, and general febrile 
symptoms many times supervene. The symptoms of this 
disease are sometimes so diversified as to lead to unfounded 
suspicion of many other diseases. We have seen patients 
treated for dyspepsia, liver-complaint, inflammation of the 
womb, hysteria, gonorrhoea, gravel, worms, fits, and even fe- 
ver, who were only laboring under cystitis. 

One case, a female aged twenty-five years, who was not out 
of bed for nine months, and who was treated all that time for 
inflammation of the womb, by a celebrated physician, who had 
tortured her with the actual cautery over the bowels, so much 
that he could no longer heal the wounds his "hot-iron" had 
made. He seems, however, to have a kind of mania for the 
actual cautery, as we are told he has his iron in the fire nearly 
all the time, and cauterizes for nearly every disease. 

Another case, a little girl aged ten years, who was so violently 
afflicted as to be sometimes convulsed. She was treated succes- 
sively by three physicians for fever, for worms, and for epilepsy, 
neither of them having examined the urine, nor ever once 
suspected the true cause of the disorder. 

A number of other cases of this disease have came under 
our notice, which wo have suddenly relieved, because of the 
true nature of the case being made known to us through the 
urinary deposits. 

Although vesical mucus may be nearly always present in 
healthy urine, in these cases it is exhibited in largo quantities. 



120 Urino-Pathology. 



in an irregular, white gelatinous mass, which adheres to the 
bottom of the glass, or floats through the urine in an aggrega- 
ted form which can not be dispersed by agitation, nor mixed 
with the urine. 

This characteristic is alone sufficient to determine it from 
pus, which it resembles. 

To test it, add a little acetic acid, which will coagulate it 
into a thin membrane. Sulphuric acid will not dissolve it, and 
ferro-cyanide of potassium throws down a precipitate. For 
microscopic appearance, see Chart, Fig. 11. 

Treatment : Diuretic emulsions and mucilaginous drinks, 
combined with syrup of poppy, and other sedatives. 



INFLAMMATORY RHEUMATISM 



This, the last on the list of inflammatory diseases which 
we shall take upon ourselves to diagnose hy the urinary 
secretion, is one in which the theory, as well as the practi- 
cability of our peculiar system, is made manifest to every 
observing practitioner as being substantiated by the highest 
authority. 

"After the most mature consideration of this subject," 
says Dr. Robertson, " based not only upon what has been 
written by the most experienced authors, but also upon the 
results of minute observatins in practice, we long since came 
to the conclusion that genuine uncomplicated rheumatism is 
always connected with an excess or redundancy of the fibrin- 
ous constituents of the blood. 

" The state of the blood, too, when drawn, very generally 
shows that there is a redundancy of fibrin." 

Dr. Buckler says : " In acute rheumatism the disease is 
seated in the blood." 

The blood in acute rheumatism, accompanied by fever, al- 
ways exhibited the character of inflammation. In the period 
of acute pain and fever, the fibrin always existed in much 
larger proportions than in normal blood, and if, by repeated 
bleeding, the fibrin was reduced in quantity, upon the subsi- 
dence of pain, in those cases in which the pain and fever 
returned, an increase of fibrin was again observed, according to 
the experiments of Andral and Gavaret. 

The acuteness of pain seems to have as great an influence 
on the increase of fibrin as the Stage or duration oi' the dis- 
ease, the blood containing as large an increase of fibrin at 
the commencement of a fever attack as at a later period in 
a milder case. 



122 Urino-Pathology. 



Simon says : " We have already seen that the blood in 
rheumatism perfectly corresponds "with the blood in true in- 
flammations ; hence we are led to infer that the urine will 
also present the inflammatory type — an inference confirmed 
by experiment." 

It will exhibit in the acute stage those characters of in- 
flammation which have been so often presented, in a very 
high degree, the extent depending upon the violence of the 
attack. 

As the rheumatism becomes chronic in its character, and 
without fever or inflammation, as Eisenman remarks, the pro- 
perties of the urine may undergo a change ; and instead of 
being acid it may assume an alkaline reaction, and give off 
a fetid ammoniacal odor. 

Urine in rheumatism often throws down sediments, even 
at the hight of the disease, when the deposits formed may 
be regarded as significant of a true crisis, if the supernatant 
urine is perfectly clear. 

The disease, then, being seated in the blood, and having 
found one constituent always to be in excess in that fluid, 
under these circumstances we will expect, according to the 
physiological function of the kidneys, to find an excess of 
that substance thrown off by the urinary secretion, when they 
perform their functions aright ; and such we find to be the 
case. 

But there are other signs in this important condition, 
which give farther clue to the nature of the case. 

"As surmised by physicians in all ages,** says Dr. Lewis, 
" it is apprehended that by acting on the blood we can really 
reach the materia morbi in rheumatic affections ; the modern 
opinion of an excess of uric acid in the blood being, if not 
the proximate cause, at least mainly instrumental in con- 
stituting the disease, is confirmed by the effect of remedies 
that relieve it." 



Urino-Pathology. 123 



Colchicum appears to be the great remedy, and all agree 
that the uric acid deposits in the urine are always more than 
doubled under its use. 

So fully satisfied have physicians become of the excess of 
urea and uric acid in the blood of rheumatic patients, that 
some have christened the peculiarity with the technical term 
of diathesis, uric acid diathesis, or disposed to excess of urea 
in the blood, and deposits of uric acid or urea in the urine ; 
hence persons disposed to acute rheumatism are those having 
that excess. 

In this disease, therefore we will always find the general 
characteristics of inflammation presented in the quality of the 
urine, together with an excess greater or less of these de- 
posits. The urine will be very highly colored, tinged with red- 
dish floculi, and loaded, as it were, with a thick, dense cloud, 
visibly suspended in it, and on cooling will become turbid, final- 
ly, will throw down such large quantities of uric acid, as said 
by Dr. Buckler, " resembles the washings of a wine-cask or 
beer-barrel." This very great excess, however, generally 
takes place only on the crisis forming, or at the period of 
convalescence. 

The urine in this disease is always acid, hence it reddens 
litmus-paper. " It presents every shade* of tint," says Bird, 
" from the palest fawn-color to the deepest amber or orange- 
red," hence the name of red sand, is applied to these de- 
posits. 

The specific gravity of the urine in this disease, is always 
above the average, and, as in a generality of cases of urine, the 
deeper the color the greater the density, and vice versa, the 
lighter the color the lighter the specific gravity. The prac- 
ticed eye will soon detect, with great precision, the probable 
weight of the urine, without the aid of a gravimeter. 

For microscopic examination, if a great number o\ crystals 
are desirable, by the addition of a little hydrochloric acid, a 
great abundance will bo deposited. 



124 Urino-Pathology. 



This examination may be conducted in the manner as 
recommended by Bird, or as given in treating inflammatory 
fever, to which this is very nearly allied, which see. 

This closes our examinations of inflammatory diseases, any 
one of which here mentioned, may be easily determined by 
inspection and analysis of the urinary secretion by the tests, 
reagents, and microscopic appearances. 

Every one should be well acquainted with the appearance 
and composition of urine in a normal state, before entering 
upon the practical application of its principles to medicine. 
We should be prepared to recognize it in every condition, 
and be acquainted with each of the constituent principles in 
all the several changes. For, " more than all other signs," 
says Simon, " the correct examination of the urinary sedi- 
ments, is of importance to the physician. Healthy urine 
forms only, after long standing, a light, sinking cloud of ves- 
ical mucus ; every other separation in the urine is of a patho- 
logical nature*" 

Treatment : Diuretic medicines, the alkaline salts, or what- 
ever defibrinates the blood, eliminates or dissolves and dis- 
charges the uric acid, and removes the peculiar diathesis. 

Nitrate of potassa has been highly extolled in this disease ; 
but iodide of potassa, in connection with nervine tonics, seems 
to be more effectual, however. Colchicum is undoubtedly a 
good remedy, in many cases, but will require nervine tonics 
in connection. Macrotin, however, seems to possess the 
properties more in combination, and to be more effectual in 
removing this complaint than any other single remedy; or 
the tincture of macrotys racemosa, which we prefer to the 
concentrated preparation. 

Whatever the remedy, it is required to begin in full doses, 
even to the production of their own peculiar characteristic 
symptoms or constitutional effects. 



Urino-Pathology. 125 



The treatment of acute rheumatism and all inflammatory 
diseases, by nitrate] of potassa, would seem, however, to be of 
considerable pathological interest, since it is asserted, upon 
good authority that it is a powerful solvent of fibrin. 

" We know," says Simon, " that nitrate of potassa is a 
powerful solvent of fibrin," and we are thus enabled to in- 
terpret the efficiency of this remedy, in accordance with our 
knowledge of these diseases. 



FEVERS IN GENERAL. 



We are fully satisfied that the existing causes of all dis- 
eases are first manifested in the circulating fluid, the blood ; 
and especially is the proof abundant in the case of the dif- 
ferent fevers, so called, whether the cause be in the change 
of its proportionate constituent principles, or in the delete- 
rious, abnormal or morbific agents introduced therein. 

"The seat of fever," says Beach, "is in the blood-vessels, 
or vascular system, hence it is evident that the exciting cause 
must be in the blood/' It has been shown by many patholo- 
gists that the blood in different forms of fever is in a morbid 
or vitiated state. It has been subjected to chemical anal- 
yses in nearly every disease, and all tend to show that previous 
to the other signs of attack even, the blood is materially alter- 
ed in its properties, and that its constituent principles undergo 
progressive changes as the disease progresses. Hence, Dr. 
Stevens considers this diseased state of the blood as the first 
link in the chain of morbid phenomena which constitutes 
fever. He believes that the serial poisons from which all 
pestilential diseases arise, are carried with the atmospheric 
air into the circulation, mix directly with the blood in the 
pulmonary system; and that this poisoned or diseased state 
of the whole circulatory current is the cause of the subse- 
quent morbification in the solids. 

" The blood is not only materially changed in fever," says 
Beach, " but the diseased state of the blood precedes the at- 
tack, and the changes take place in a determinate order." 

Laurentius Bedine thus defines fever : " Fever is a faulty 
state of the blood in either motion, quantity or quality, or in 
all of these respects." 

Now, the most frequent alteration in the character of the 
blood in all idiopathic fevers, as they are called, is known 



Urino-Pathology. 127 



to consist in the diminution of the natural proportion of its 
fibrin, "and that the degree of this diminution is very uni- 
formly proportioned to the severity of the disease," says one 
author. 

This, it is observed, is the reverse of that which is always 
found in inflammatory fever, as may be seen by referring to 
that subject, as treated in preceding pages ; and is an import- 
ant fact which is necessary to be borne in mind in all the 
examinations. In proof of this, read the following : 

" It is obvious," says Carpenter, " that increase of fibrin in 
the blood does not exist as a result of these fevers. In 
typhoid fever the (Jecrease in the proportion is much more 
decidedly marked, and as a favorable change occurs in the dis- 
ease, it again approaches the normal standard." 

Dr. Andral has observed a marked diminution of fibrin in 
the blood in all idiopathic fevers. 

Without going into a history of all the phenomena of the 
different kinds of fever, it will be sufficient for our purpose 
in this place to state that, in all idiopathic fevers, there is 
not only a decreased state of the blood, but that there is 
a derangement of the secretions also, as is indicated by the 
dry tongue, increased thirst, hot skin, and scanty and high- 
colored urine, which is altered in appearance and constitu- 
ents. "It is the case," says Beach, "that fevers and other 
inflammatory diseases are brought to a favorable termination 
by a spontaneous discharge of urine." 

In view of this universally altered state of the blood, and 
its difference from other diseases, and also the corresponding 
alteration in the constituents of the urine at the same time, 
we have only to learn in what that alteration in the urine 
consists, to determine from that secretion, the character oi 
the fever. 

The urine then, in idiopathic levers, is generally " scanty 
and high-colored," but Ave must- remember that it is unlike 
that of the inflammatory, in being destitute o( the "reddish- 
tinged floculi," which added brightness to the! color in the 



128 Urino-Pathology. 



latter. There will not be even a normal quantity of that 
substance found, but rather a proportionate deficiency, which 
deficiency is generally made up in the abnormal quantity of 
other matters. 

The high color of the urine is partly occasioned by the 
degree of concentration which that fluid takes on, because of 
its scantiness, together with the peculiar substances trans- 
mitted to it from the circulating fluid. It is these substances 
that give to each specimen a distinct peculiarity of its own, 
according to the kind of fever, thus : The chemical pathol- 
ogy of bilious or remittent fever, reveals the fact, that this 
disease spends its action more upon the liver than upon any 
other organ; while that of intermittent fever is spent more 
upon the spleen, as indicated by a tenderness over that re- 
gion, and an enlargement of that organ in protracted cases ; 
and that of typhoid fever more upon Peyer's glands, and so 
on, as is well known to all medical men. 

Now, in each of these fevers, while we will find the urine 
always highly, or we might say, deeply colored, measurably, 
because of its great concentration, the color somewhat re- 
sembling " strong ley," and deficient in the metamorphosed 
fibrinous matter, and also certain other peculiar substances, 
according to the organ or part predominantly affected, as the 
liver, splean, Peyer's glands, etc., in accordance with these 
characteristics will we find the type of the fever. 

These several peculiarities will be noted under the respect- 
ive head to which they belong. We will close this article on 
fevers in general, with a few quotations found in Beach's 
American Practice, Vol, II. 

1st. A deranged state of the secretions invariably pre- 
cedes the occurrence of the slightest degree of excitement. 
This we think will hardly be disputed by any one. 

2d. The pre-existence of such a condition being admit- 
ted, its adequacy to promote the excitement can not, we sus- 
pect, be questioned. 



Urino-Pathology. 127 



3d. In proportion as the secretions become re-established, 
the excitement invariably diminishes. 

4th. The excretions, upon the decline of the fever, invari- 
ably contain a much larger quantity of salts and other matter 
than they do in their ordinary state. We need only refer 
to the urine, which is so loaded with these substances, that 
a copious deposit takes place almost immediately after it has 
been voided. This affords an additional proof that there does 
actually take place, during the progress of fever, an accumu- 
lation in the blood [of matter, which in a state of health, is 
regularly excreted by the kidneys. 



INTERMITTENT FEVER. 



The cause of intermittent fever is now pretty generally 
conceded to arise from what is termed malaria, a certain poi- 
sonous gas, which mixes with the blood, and becomes so ob- 
noxious to it that a new action is set up in the system to 
expel it from the circulation. 

We need not mention all the strange phenomena that gen- 
erally characterize this fever, but only point out some of the 
never-failing concomitants which distinguish it from other dis- 
eases, the principal among these are : regular and distinct 
periodical return of chills, and the universally deranged con- 
dition of the spleen. 

By whatever influence the blood may have become con- 
taminated in this disease, whether by malaria or other poison, 
or by a deficiency alone of the fibrin of the blood, it is 
certain that a deranged condition of the spleen is universally 
present. 

Maillot thinks that in most cases there existed some lesion 
of the spleen before the accession of the fever. Dr. de la 
Bae refers the element of periodicity to the introduction into 
the blood of an acid ( probably malaria ), and Dr. M. Roche, 
to the contamination of the blood by malarial poison.) 

Now, it appears to us that the deranged condition of the 
spleen alone (perhaps because of the malarial poison), gives 
rise to the periodicity, as well as the other equally myste- 
rious phenomena belonging to this disease. 

The spleen is a spongy viscus, of considerable magnitude, 
and is connected by ligaments, vessels, etc., with the stomach, 
kidneys, omentum, diaphragm, peritoneum, pancreas, colon, 
etc., and yet, "its use," says Hooper, "has not hitherto been 
determined, at all events, is very little known." But of its 
derangement in this affection, as well as its altered structure 
in protracted cases, no one can for a moment doubt. 



Urino-Pathology. 129 



Of all the organs of the body," ( says Prof. Paine, in 
speaking of intermittent fever, ) " the spleen is the most uni- 
formly affected. It is not only changed in structure, but be- 
comes very much enlarged, and in all fatal cases proves to 
be the principal organ on which the disease has spent its 
force." 

" In the worst forms of intermittent fever," says Beach, 
" the effect is aggravated by the great intensity of the mala- 
rial poison ; the blood not only stagnates but accumulates in 
an altered state, prone to decomposition, and in these cases 
the spleen is represented by writers as resembling a bag of 
tar, the blood being as black as pitch." 

" There seems to be some noxious influence produced by 
the spleen, in a diseased state, which impairs the making of 
blood ; the large diseased spleens are like bags of spoiled 
blood, the return of which into the circulation injures and 
reduces the other blood, and keeps up a continued disease." 

"The spleen, in periodical fever," says Bartlett, "is almost 
always enlarged, softened, and of a very dark or bluish-black 
color. This lesion is so constant, and has been so long 
familiar to all observers of this class of diseases, that it is 
hardly necessary to multiply cases, or to quote authorities." 

"We have often seen these subjects," says Bailey, "ar- 
riving at the hospital in Rome, with abdomen as hard as a 
stone, the spleen occupying the whole anterior part of the 
cavity." 

Enough, we think, has now been given on this subject to 
satisfy anyone that in intermittent or periodical fevers, the 
blood is primarily affected with a tendency toward spending 
its action more upon the spleen than upon any other organ, 
and that it is to this peculiar change in the blood, producing 
this effect upon the spleen, that gives the otherwise unac- 
countable periodicity to this fever. 

Now what arc the facts in regard to the state of the urine, 
in this disease, and do they bear any relation to this view 
of the case ? 



1 30 Urino-Pathology. 



Prof. Eberle says : " In the cold stage of this fever, the 
urine is clear, colorless, without sediment and often copious ; 
in the hot stage, scanty and deep-colored, without sediment. 
In the sweating stage, the urine, though still very high- 
colored, deposits a lateritious or pale-red sediment." 

It will readily be observed here that, in each of these stages 
there is found to be a change in the character of the urine, 
corresponding with the change in, or stage of the disease. 

Dr. Bartlett says : " In the cold stage the urine is gener- 
ally abundant and limpid ; in the hot stage it is scanty and 
high colored ; and in the sweating stage, the urine deposits 
a reddish sediment." 

Dr. Beach makes very similar statements to those of Eb- 
erle and Bartlett, in regard to the urine in this disease ; as 
also does Prof. Paine, who adds that " this fever is gener- 
ally preceded by alternate changes in the urine, which char- 
acterize the type of the approaching disease, by occurring at 
the same regular intervals and lasting the same length of 
time." 

Dr. Lenac lays still greater stress on the appearance of 
the urine, as characteristic of periodical fevers. " Masked 
intermittents," he says, " may be no less certainly detected, 
as was formerly observed by the color of the urine. In this 
disease the urine is very often lateritious during the remis- 
sion, which is a sign almost infallible, that it belongs to this 
family." 

According to Dr. Currie, " the urine during the cold stage 
is pale, copious, and crude, but as soon as the hot stage is 
established it becomes high-colored, while in the remission it 
is thick and cloudy ; and sometimes deposits a brick-colored 
or brownish mucous sediment." 

Dr. Boling says that the secretion of urine is scant, highly 
colored and muddy, during the exacerbation, from the color- 
ing matter floating suspended in it; and sometimes late in 
the disease is of a deep reddish-brown, possessing apparently 
a degree of consistency greater than natural, etc. 



Urino-Patholoyy. 131 



What remarkable coincidence of opinions among learned 
authors, without having attempted any philosophical, or path- 
ological explanation of the causes, or ever once attributing 
the "universally the same" condition of the urine under like 
circumstances in this disease, to the uniformly diseased state 
of the blood, and to the uniformly alike-affected condition of 
the spleen in the same disease ! 

It may appear that enough has already been said to ena- 
ble anyone to detect a case of intermittent fever, by the 
characteristic appearance here given of the urine alone ; and 
we shall only mention in conclusion, the facts that the spleen 
in this disease, according to Paine, always yields a peculiar 
elastic resonance, and that according to Bird, the presence 
of an excess of purpurine in the urine is almost invariably 
connected with some functional or organic mischief of the 
liver or spleen, and that the pink deposits which are almost 
constantly present in the urine ( in these cases ) , are always 
to be found in the hypertrophy of the spleen following ague. 

There is a deficiency of fibrin in the blood, and conse- 
sequently a deficiency of this element in the urine. The 
urine is always alkaline to test-paper, and contains urate of 
ammonia in excess. (See Chart, Fig. 5). 

" The sediment formed in the urine in intermittent fevers, 
is always composed of uric acid and urate of ammonia, in 
most cases combined with red coloring-matter, (uroerythrin. ) 
( Simon ) . 

The high color of the urine is generally owing to excess 
of purpurine — if so, alcohol will take up the purpurine, leav- 
ing the urine more clear. Urate of ammonia disappears 
with slight heat and reappears on cooling ; and liquor- 
ammonia or potassa will dissolve it when in deposit. 

A microscopic examination of urate of ammonia may be 
made by placing a drop of the turbid urine between two 
plates of glass ; an amorphous powder will be visible under 
the microscope, which will be readily recognized by eompar- 



132 Urino-Pathology. 



ison "with the figure representing it in the Chart, or with a 
" prepared specimen." 

Treatment ; Remove the congested state of the spleen, and 
the circulating fluid thus : 1st, Give an emetic of Euphorbin 
and Lobelin, then small doses of podophyllin and eupurpurin. 
2d, Relieve the periodicity with cypripedium, salicin, cincho- 
nin and acidulated drinks. 3d, Tone up the system with 
lemon-peel, iron, hydrastis and wine — to guard against, or 
or prevent a relapse. 

If the chronic enlargement of the spleen has supervened, 
an irritating plaster over the region will be of service. 



REMITTENT FEVER. 



We have dwelt longer on intermittent fever, because of 
one of its main peculiarities (periodicity), being, in many 
cases, a partial characteristic in this and other fevers. In 
fact, in whatever disease, if the spleen in any way becomes in- 
volved, periodicity will be one of the concomitant symptoms. 
Hence we will not unfrequently find it participating in a 
slight degree in this, because of the spleen being partially 
affected also. 

Of all the organs of the body, however, the liver is the 
one universally affected in remittent fever. " There is good 
reason for believing," says Bartlett, " that the lesions of this 
organ constitute the anatomical characteristic of this disease." 
When we consider the position of the liver, its office as a 
depurating organ, its importance in manufacturing bile, as it 
were, and its general relation to the process of purifying the 
blood ; and that in remittent fever the liver, more than any 
other organ, is the one most uniformly and constantly affected, 
it is certainly to the peculiar phenomena produced by such 
affection, that we are to look for a solution of the nature of 
the disease. 

The natural color of the liver in health, is a deep red, or 
reddish-brown. In remittent fever Dr. Robertson made post- 
mortem examinations in a great many cases, and found the 
color to be nearly the same in every case, but very different 
from the natural. 

In most of the cases he described the liver as being the 
color of bronze, or a mixture of bronze and olive. 

" The most correct idea of the color before us," says Bart- 
lett, " perhaps would be conveyed by stating its predominant 
character, the same in every case, to be a mixture o\" gray 
and olive, the natural reddish-brown being entirely extinct, 
or only faintly to be traced." 



134 Urino-Pathology. 



Dr. Gerhard's cases in the Blockley Hospital presented the 
same appearances. In all of Dr. Sweet's cases in the New 
York Hospital, the peculiar change in the color of the liver, 
described by Dr. Stewardson, were present. Also, in the 
cases summed up by Dr. Stille ; "in all, the color of the 
liver was either bronzed or like that of slate." 

Dr. Stewardson very naturally suggests that this altera- 
tion of the liver may be found to constitute the essential 
anatomical characteristic of marsh-fever, as the lesions of 
Peyer's glands and the lymphatic ganglia constitute that of 
typhoid fever. 

In this fever, the blood is changed in quality, and ren- 
dered both chemically and mechanically unfit for the purposes 
destined by nature, and is different in character from that 
of any other fever ; the peculiar character of the lesions be- 
ing dinerent, as the foregoing shows. It is sometimes termed 
bilious fever, because alone of the bile which enters the cir- 
culation of the blood and thereby changes its constituents, 
pervades the tissues and gives a yellow-color to the skin, is 
secreted from the blood by the kidneys, and alters the chem- 
ical qualities and appearance of the urine. 

The urine in bilious fever is usually impregnated with bile- 
pigment ; it is of a more or less brownish color, and when a 
thin layer is seen it appears of a citron-yellow tint ; it dif- 
fers, however, with the degree of vascular excitement. The 
presence of bile-pigment may always be recognized by the 
change of color which succeeds the addition of nitric acid. 

"The urine is thick and of a dark-yellow color/1 says 
Paine, " and in the latter stages scanty and muddy." 

" The eyes and skin assume a yellow-tinge," says Beach, 
" and the urine is scanty and of a yellow-color, and mixed 
with bile." 

In bilious fever then, when the leisons of the liver uni- 
versally present the appearances' represented by eminent 
authors here mentioned, and the blood is so uniformly altered 
in constituents, there being a deficiency of the fibrinous 



Urino-Pathology. 137 



substance, and an abnormal proportion of the biliary mat- 
ters, the urine being secreted from this state of blood, we 
could not philosophically or in any other way, expect to find 
a normal state of that fluid during such a state of the human 
system. 

But, on the contrary, we find the urine participating in the 
same characteristics of the disease, in so prominent a manner 
as to identify it fully in every case. 

The urine not only takes on the peculiar brownish or 
bronzed appearance observed in no other disease, but it par- 
takes largely of the contaminating matters with which the 
blood has become surcharged, because of the unhealthy bile 
entering the circulation, and hence will exhibit the greenish 
or bilious tinge also. 

"Bile often tints the urine of a deep-brown color, also," 
says Bird, " and may lead to an unfounded suspicion of 
blood." 

But no one at all skilled in the ocular inspection of urine 
in disease, will ever be deceived in this for a moment; yet, 
if there should be a doubt at any time, the very convenient 
nitric-acid test will soon decide. 

It would be well for every learner to obtain a specimen 
of urine from a well-marked case of bilious fever, and in 
fact, every other disease, seal them up and preserve them 
for frequent examination and comparison, to familiarize them- 
selves with the appearances. 

The deep, heavy-brownish or bronze-tinged urine, which 
is hard to describe, because of its peculiar mixture of color- 
ing matters, may be very readily recognized, however, by a 
comparison with other urine, or with the urine of health 
even. 

Its chemical constituents, however, will more readily detect 
or determine the extent of the disease by the quantity of 
abnormal, or excess or deficiency of any constituent. 

It generally deposits purpuratc of ammonia in abundance, 
in connection with a. peculiar substance, the disintegrated 



138 Urino-Pathology. 



particles of the liver itself, they being of the grayishor bronze- 
color, before mentioned. 

When the spleen is at all implicated in this fever, there 
will be traces of urate of ammonia in the urine, as in inter- 
mittents, and the fever will be somewhat marked by the usual 
symptom of periodicity. These substances may be readily 
recognized by their tests, and the microscope ; if bile, test with 
nitric acid. 

The urine will be alkaline to test-paper ; specific gravity 
will be high; will be reddish-brown, or mixed with bronze 
or gray, and will deposit purpurate of ammonia, with -perhaps 
urate of ammonia. 

Treatment : First, an emetic of Lobelin and Euphorbin, then 
moderate doses of leptandrin, oft-repeated through the day ; 
and podophyllin and diaphoretics at night, with dandelion-tea 
throughout the disease. 



TYPHOID FEVER. 



Of all the fevers which prevail in this and the northern 
portion of our country, there is none to be dreaded more 
than typhoid fever. 

Its peculiar lesions have given rise to various names for 
this formidable complaint, such as entero-mesenteric, abdom- 
inal-typhus, intestinal-ulcerating-typhus, typhus-gangliaris, etc. 

As it is our object only to give the pathological condition of 
the blood so far as it relates to the consequent changes pro- 
duced in the urine, and the lesions or other peculiarities that 
may have a bearing upon that fluid, we will proceed to the 
special case. 

" The most frequent alteration in the character of the blood 
in this fever," says Bartlett, "consists in the diminution of the 
natural proportion of its fibrin." 

Andral and Gavarret found that in typhoid fever the pro- 
portion of fibrin in the blood was never increased above its 
natural standard, but on the contrary, that in many cases 
this proportion was very much diminished ; and, furthermore, 
that the degree of this diminution was very uniformly pro- 
portionate to the severity of the disease. Here, then, is the 
measure of the severity or extent of the disease itself, in 
whatever measure of deficiency of fibrin from the natural 
standard in health. 

The blood in typhous abdominalis exhibits a diminution of 
fibrin from the commencement, and that element never rises 
above the normal standard, in true typhoid. This decrease 
of fibrin is almost always connected with an increase of the 
blood corpuscles and solid constituents, also, until the disease 
approaches the stage of collapse. As this stage is approached, 
the fibrin still decreases, but a remarkable change comes 



^ 



140 Urino-Pathology. 



over the blood corpuscles and the solid constituents (in con- 
sequence of the liquor-sanguinis being too -watery and defi- 
cient in salts), and these decrease also. x\s soon, however, 
as any symptoms of convalescence appear, the fibrin begins 
to increase, and this continues to be the case during the 
progress of convalescence, during which progress the corpus- 
cles simultaneously and correspondingly decrease. Now, these 
changes in the blood will give corresponding changes in the 
urine, and M. Primavera, who has been observing the constit- 
uents of urine, makes the following statement in reference to 
the urine in typhoid fever: 

1st. The complete absence of the chlorides from the urine 
is a pathognomonic diagnostic sign of typhoid fever. This 
valuable sign will serve to distinguish this fever from a simple 
and benignant fever, continuous or intermittent, in which the 
urine always contains an appreciable quantity of salts of this 
nature. 

2d. Urine passed during the ascending period, or even 
during the whole course of typhoid fever, when this has a 
fatal issue, shows not only an entire absence of the chlorides, 
but even a very considerable diminution of the phosphates 
and urates. 

3d. The first step toward convalescence is indicated better 
than by any other sign, by a very rapid and sensible increase 
of the phosphates. 

4th. The second phase of amelioration is shown by an 
analogous increase of the urates. 

5th. Finally, the re-appearance of the chlorides in the urine, 
however tardy, definitely indicates the recovery of the patient. 

The peculiar lesions which characterize this, is different 
from every other also. " In all cases of typhoid fever," 
says Bartlett, " there is lesion of the small intestines. This 
lesion is peculiar. It is found in no other disease. It is 
generally extensive." 

He then goes on to state that constituting, as this lesion 
does, the characteristic, and of course, the most interesting 



Urino-Pathology. 141 



and important pathological clement of typhoid fever, he will 
describe it with all possible accuracy and completeness, etc. 

The invariable and characteristic lesion found in the small 
intestines, consists in alteratiens of the elliptical plates, or of 
what are called "Peyer's glands." These plates or glands are 
more or less extensively the seat of ulcerations, sometimes 
amounting to a perforation of the intestines, through which 
their contents may be discharged into the peritoneum. 

Peyer's glands are sometimes so morbidly affected, or 
changed in this fever, that there is deposited in the cel- 
lular tissue a substance of a yellowish-color, that has been 
denominated typhous matter. 

Dr. Bartlett says that the conclusion to which he is irre- 
sistibly led, is that the connection between the diagonistic 
symptomatology of typhoid fever, and the entero-mesenteric is, 
we will not say absolute and invariable, but as nearly so as 
the connection between the diagonistic symptoms and the char- 
acteristics lesions of any disease whatever, in the nosology. 

What is the nature of this alteration of " Peyer's glands?" 
asks the same author, and concludes by attributing the lesion 
to inflammation, not of a common, but of a specific char- 
acter, having something peculiar in its nature, in regard 
to the condition of the blood; and that this fever con- 
sists essentially in this lesion, and refers the symptoms 
to the lesion as their cause, the blood being affected thereby. 

In all cases wherein the typhoid state or the typhoid ele- 
ment in pathology has been present, important and peculiar 
changes have taken place in the blood; "therefere, there is 
good reason," says an author, " to think that the changes 
thus produced upon the blood play a very important part 
in the pathology of the disease." 

The peculiar alteration in the blood, whether produced by 
the action of malarial poison directly upon the blood, or 
primarily, upon Peyer's glands, thence upon the blood, mat- 
ters not, for our purpose, so long as the effects upon these 
glands and the blood are so simultaneously and uniformly 



142 Urino~Pathology : 



present; for it is in the urine secreted from this diseased 
condition of the blood, that we are to rely principally for 
the diagnosticating substances passed therefrom. 

"The kidneys do not only secrete" says Lehman, "cer- 
tain constituent atoms of organs, -which have become unfitted 
for the purposes of life, but also the excess of nutritive mat- 
ters," etc. 

" M. M. Solon," says Dr. Wood, " has paid particular 
attention to the state of the urine in this disease. He has 
found it to be more scanty, higher colored, and denser than 
in health, equally acid, if not more so ; much more abundant 
in urea, and occasionally albuminous, especially in severe 
cases, in which this character of the secretion must be con- 
sidered an unfavorable sign." 

It is well known that retention of the urine is very fre- 
quent in this form of fever, and is one of the particular 
marks which distinguish it from other forms of continued 
fever. 

Dr. Nathan Smith says : " In the commencement of this 
fever the urine is not high-colored, and is considerably copi- 
ous, being often above the natural quantity, and deposits no 
sediment. In voiding it into a glass it often foams like new 
beer. As the disease advances, the urine becomes more- 
highly colored ; and as it begins to decline, lets fall an abun- 
dant sediment." 

Drs. Dobler and Skoda inform us that whenever the disease 
is at all severe, the urine deposits no sediment, unless it be 
a slight mucous cloud, but on the subsidence of the fever 
there is often a dirty-grayish deposition. 

It appears from the observations of Schonlein and Simon, 
that in typhoid fever the urine is at first very acid, subse- 
quently, neutral, and even alkaline, and again acid at the 
commencement of convalescence. 

Carbon, azote, hydrogen and acids, all seem to be retained 
in the blood in this disease, because perhaps of the partial 



Urino-Paihology. 



retention, or scanty secretion of urine ; and the perspiration, 
urine, and excrements, are all generally acid. 

The urine will be acid, especially in the first stage ; it will 
be loaded with the "bead" or bubbles of carbonic acid, will 
be tolerably clear until the second stage or greater violence 
of the disease, when it will be found more highly or darker 
colored, and will emit a very strong odor. 

In the latter stage when ulceration of the glands of the 
intestines has supervened, the urine will become cloudy and 
thick with a mucous-like substance, which, on repose, deposits 
a dark muddy-like matter, indicative of serious disorganiza- 
tion of these parts, and dangerous dissolution of the blood. 

So plainly is this condition of the system manifested in 
this appearance of the urine, that no prognostic sign of ap- 
proaching death can be more safely relied upon. A prog- 
nosis of the approaching end of life can be definitely made 
out from the peculiar dark or blackish muddy-like appear- 
ance of the urine, sometimes several days or a week even be- 
fore the final cessation of life — as we have often been called 
upon to do. 

This peculiar characteristic of the urine, although not easily 
described, yet when once observed scrutinizingly, will forever 
after be remembered. 

Treatment : Avoid drastic purgatives, restore the suppressed 
secretions, especially the urinary, and keep up the tone and 
strength of the system. Give leptandrin, terebinthinatc diu- 
retics, and Peruvian-bark tonic, with alkaline sponge-baths, 
and soda drinks. 



YELLOW FEVER. 



In this disease we have had no practical experience what- 
ever, and therefore can not be expected to give much valu- 
able information concerning the state of the urine therein. 

From the history of this much-dreaded disease in warmer 
climates, it seems, however, that some deducible facts may 
not be out of place. 

The blood in this disease is described as watery, very poor 
in fibrin, and of a dark color. If any clot be formed, it is 
diffluent, and very soft. The serum is of a deep yellow or 
brown-red color, partly from the coloring matter of bile and 
partly from dissolved hemato-globulin. It possesses a very 
peculiar smell, and Schonlein and Chomel both speak of a 
peculiar gas developed in the veins, which escapes with the 
blood, in post-mortem examinations ; Ancel remarks that in the 
first stage of this fever the blood is of a brighter red, con- 
tains more salts, and is hotter than in a state of health. As 
the disease progresses it loses its saline and animal princi- 
ples and becomes black and thin. 

Balard is of the opinion that the lymphatic system is first 
disordered, and that inflammation, degeneration, and suppura- 
tion of the lymphatic ganglia and vessels follow. When the 
disease is fully established the arterial and venous blood have 
both the same dark color, and appear in a peculiar state of 
solution. 

All those pathologists who have written on the subject of 
this fever, agree that the most important element in its 
pathology is to be found in the peculiar alteration of the 
blood, together with a peculiarly striking and uniform change 
in the color of the liver, wholly different from that of the 
same organ in any other disease, and also that there is nearly 



Urino-Pathology. 145 



always an altered state of the mucous membrane of the 
stomach. 

The blood was found by Louis and Trousseau to be gen- 
erally either liquid only, or liquid and clotted ; the clots be- 
ing black, or yellow and fibrinous. 

Dr. Nott, of Mobile, found the blood dark and fluid in 
every case where the bodies were opened. He says it always 
shows a great deficiency in fibrin, and in some cases it did 
not coagulate at all. 

The uniform change in the color of the liver, is described 
by some writers as being of a straw color ; by others, of a 
yellowish gum color, a mustard color, a buff color, a pale- 
yellow color, etc., and generally hard and destitute of blood ; 
and the stomach generally contains the matters of black vomit, 
which are considered to be vitiated blood mixed with the 
altered secretions of the stomach derived from the mucous 
membrane. 

Now, in this state of the stomach and liver, together with 
the peculiarly altered condition of the blood, in which so in- 
variably and essentially consists the characteristics of this 
fever, is it not highly probable that the urine which is se- 
creted from this blood will partake of the qualities of that 
fluid, and the organs thus affected ? And, is it not passing 
strange that so little attention has been paid to that secre- 
tion in this disease, unless, like in cholera, there is generally 
an entire suppression of urine, which perhaps is the case. 

Be that as it may, however, we think if a sufficient quan- 
tity of that fluid could be obtained for examination, it would 
exhibit all the marked indications of the disease, and would 
prove a valuable prognosticating symptom, at least, and might 
lead to profitable information respecting the treatment of this 
formidable complaint. 

In Bryant's account of the yellow-fever in Norfolk and 
Portsmouth, Va., 185"), (whither Dr. Finch, who waa prac- 
ticing with me at the time, proceeded, at the instance of ihe 
" Board of Trade of Pittsburgh," to assist in ii^ treatment). 



146 Urino-Pathology. 



it is reported that there was one symptom from which death 
could be invariably prognosticated, to-wit : suppression of the 
urine. It was a certain indication of the general dissolution 
or breaking-up of the animal functions. Perhaps not one 
patient in whom it occurred survived. This suppression often 
occurred in the first stage of the disease, and yet it still re- 
mained the most certain symptom of dissolution. 

This same tendency of the suppression of the urine was 
observed by us in cholera, during that epidemic here in 1850. 
And we remember a number of cases of that disease, in which, 
on the re-establishment of that secretion, and on a recurrence 
of a plentiful flow of urine, convalescence ensued. 

Might not the efforts of physicians have been directed to- 
ward the re-establishment of that secretion, with advantage in 
yellow-fever, as we are persuaded it was to many in cholera, 
during the epidemic in Pittsburgh ? 



PUERPERAL FEVER. 



This disease is entirely different in its pathological con- 
dition from any of the before-mentioned idiopathic fevers, and 
in fact, the condition of the blood in some respects, is the 
reverse of all, excepting the inflammatory diseases. Indeed 
it seems more properly to belong to the inflammatory class 
of diseases, than to be regarded among the fevers. 

The blood in this disease has been analyzed by Heller : it 
was found to be of a very dark-brown color, but coagulated 
in the ordinary manner ; the serum was turbid, but after 
standing for some time became clear. The clot was dark, 
of a loose consistence, and covered with a strong, buffy-coat, 
over which there was a delicate membrane that presented, 
under the microscope, a finely granular appearance, and fat 
vesicles. 

Dr. Scanzoni says : " The writings of Helm, Kiwish, 
Rokitansky and Engel, show that the blood in puerperal fever 
always contains an excess of fibrin, and that this excess of 
fibrin not only constitutes the primary cause of the disease, 
but that it is, in short, in itself, the essence of genuine puer- 
peral fever." 

In the vital fluid, the blood, is found the first manifesta- 
tion of this, and every other disease. " From the vitiated 
condition of the blood/' says Ramsbotham, "this malady de- 
rives its extraordinary malignancy." 

Kigley considers that the affection commences in the blood. 
And the German schools consider this disease to depend 
upon ;i metastasis of the blood destined to form the seeretion 
of the milk, from the breasts to the peritoneum. It is upon 
the peritoneum that this disease spends its action, like the 



148 Urino-Pathology. 



spleen in intermittent, the liver in bilious, and Peyer's glands 
in typhoid fever. 

This disease runs its course in a very short time, being of 
a very malignant character, the blood very soon passing into 
a highly putrefactive state — probably from the absorption of 
the secretions of milk, urine, and lochia, which early become 
suppressed. 

The morbid condition of the blood, however, is somewhat 
allied to that of the blood in erysipelas, and the urinary secre- 
tion in these diseases, and seems to be somewhat allied in 
constituents also. And, in fact, many authors assert that 
contact with a puerperal patient may superinduce an attack 
of erysipelas in persons predisposed to that affection. 

Puerperal fever seems to be not only communicable from 
lying-in-women to patients of the same class, but from the 
children of puerperal patients being so frequently attached 
with erysipelas, and from which they generally die, it is be- 
lieved that erysipelas is superinduced thereby. 

The urine in this disease is different from that of any other 
fever. There is an increased proportion of fibrinous sub- 
stances, with, sometimes, the reddish-tinged floculi noticed in 
inflammation ; this latter is sometimes abundant and gives 
to the urine a bright and very highly-colored appearance. 

Scherer analyzed the urine in a number of cases of febris 
puerperalis, and found it usually of a fiery-red color, some- 
times neutral, often alkaline, and depositing a mixed sediment 
of pus, mucus, and urate of ammonia. In one case, how- 
ever, it resembled buttermilk, and was loaded with urate of 
ammonia. 

Bouchardet has published an analysis of milky urine, passed 
by a woman with this disease. It contained no traces of 
sugar, milk or casein, the appearance being due to a large 
amount of urate of ammonia. 

Ramsbotham says the urine is generally very defective, 
high-colored, turbid on cooling, and voided with difficulty or 
pain. 



Urino-Pathology. 149 



In the cases we have had an opportunity of examining, we 
have always found it a very highly and bright-red color in 
the first stage of the disease ; and as the disease progresses 
the urine becomes more thick and turbid, finally muddy- 
brown, and lastly, dark and muddy or coffee-ground color. 

When this latter appearance is observable, all hope of re- 
covery may be abandoned, as this is a mark, unmistakable, of 
the putrefactive state of the blood. 

The urine is generally of a very offensive odor, from the 
very commencement of the disease, becoming more and more 
so, during the increasing violence of the same. 

The urine in this disease is of high specific gravity ; is 
acid to test-paper, or neutral ; deposits uric acid crystals, 
and urate of ammonia, and sometimes pus-globules are ob- 
servable by the microscope. 

Treatment : Re-establish the secretions of milk, urine and 
lochia, and induce perspiration ; equalize the circulation and 
remove the congestion of the peritoneum. Give diluent and 
diuretic drinks, alkaline diuretic salts, neutralizing cordial, 
chlorate of potassa, tonic bitters, etc. 



SCARLET FEVER. 



This disease, like the preceding one, in our opinion, be- 
longs to the inflammatory class, or perhaps still more pro- 
perly to the eruptive ; yet its description may not be far out 
of place here. 

It is considered to be propagated by a specific, unknown 
poison, the primary location of which is in the blood, and 
for the elimination of which poison, nature seems to make 
use of the skin, as is evident in the peculiar eruption ; and 
of the kidneys, as is evident in the peculiar character of the 
urine. And, according to the experience of Dr. Bird, the 
better the development of the rash, the less the embarrass- 
ment of the kidneys, and vice versa. The kidneys, he says, 
are the organs by which the matters in solution in the blood 
are usually excreted, and in these cases, if there has been a 
deficient determination to the skin, the kidneys are made to 
do a supplementary duty. 

The blood from the very beginning appears to be loaded, 
as it were, with a morbid poison, and as the disease ad- 
vances, if this morbific matter is not removed therefrom, soon 
proves inevitably fatal, by a general disorganization of the 
vital fluid. Especially, is this sooner or later the case, if 
the kidneys have been slow to perform their duty, or fail to 
exercise their compensating function. 

Here the whole mass of the blood is contaminated by a 
specific poison or virus, and nature attempts to eliminate it 
through the medium of the skin, as is seen in the extensive 
eruption which covers the body. The supplementary duty of 
assisting in the removal of this specific virus from the blood 
is added to the already-increased duty of the kidneys, and 
in the discharges from these organs may we look for a so- 
lution of the nature of the complaint. 



Urino-Pathology. 151 



Now, respecting the character of the urine in scarlatina, 
Wilson says: "At the commencement of the disease, while 
there is considerable fever, the urine is of a deep, dark-red 
color, and possesses all the properties of inflammatory urine." 

The blood in scarlet fever, be it remembered, is of the in- 
flammatory type, containing an excess of fibrin. Also, that 
in children the urine is always less colored than in adults, 
and its color in this disease will be less dark ; hence, the 
necessity of noting the age of the patient before proceeding 
to an examination of the specimen, for reasons mentioned in 
preceding pages. 

The urine in this fever always has an acid reaction, is of a 
dark-red or brown color, soon becomes turbid, and often, says 
Schonlein, "resembles badly-fermented beer." At the com- 
mencement of the crisis the urine becomes clearer and forms a 
pulverulent sediment, consisting of uric acid. 

These are the general characteristics of the urine in the 
regular form and course of scarlatina ; but when, from imper- 
fect elimination of the morbid matter from the blood, anasarca 
sets in, which is a very common sequel to this disease, a differ- 
ent set of characteristics appear in the urine. 

Dr. Blackall says of dropsy following scarlatina, case four, 
in his work, that the urine was found so over-loaded as to 
resemble serum of the blood, three or four times diluted with 
water. It was high-colored, and contained a bloody sediment. 

The bloody sediment observed in the urine in dropsy, after 
scarlatina, indicates how nearly it is allied to true hemorrhage. 
That it does actually derive its color from the presence of red 
blood, is evinced by its appearance, which can hardly deceive : 
by its being so speedily deposited, and by its remaining undis- 
solved when heat is again applied. 

Von Roscnstcin states that the urine is mixed with blood in 
some patients, when the body swells after scarlatina. 

Bcrscrius describes it as, turbida et fusca, et quandoque 
omilino SUppressa; and adds, in a note, that it had been found 
to resemble in color, water in which flesh had been washed. 



152 Urino-Pathology. 



Dr. Blackall gives quite a number of cases of dropsy follow- 
ing scarlatina, and seems to think that in all cases where the 
urine is coagulable, the tincture of digitalis is the sine qua 
non — the only remedy needed. He gives a number of cases 
in which the unloading of the urine by this medicine was 
effected in a short time, the improvement of the urinary dis- 
charge being simultaneous with the relief of the symptoms. 

And, in some cases, wherein the medicines after having 
nearly brought about a natural state of the urine, and con- 
sequent return to health, by being discontinued too soon, " a 
return of the symptoms came on, the urine altering in the 
same proportion, and it was only by returning to the same 
medicine that a perfect recovery took place." 

The tests for determining blood in the urine, as also that 
of albumen, both of which are of frequent occurrence in the 
sequela of this disease of infancy or childhood, will be found 
in another part of this work. 

" In scarlatina," says Dr. Simon, " the urine is observed to 
be turbid at the time of desquamation ; often, also, before the 
occurrence of the same on the outer cuticle, an extraordinary 
great quantity of the epithelium of the vesical mucous mem- 
brane is seen in it." " It is, therefore," says the same author, 
"to be admitted that the desquamation goes on also on the 
mucous membrane of the bladder, and if, as frequently ap- 
pears to be the case, the scaling-off takes place earlier on 
the mucous membrane of the bladder than on the external 
skin, one may determine the commencement of the desqua- 
mation even by examining the urine." 

With the high-colored urine of inflammation, and the excess 
of uric acid crystals, the age of the patient, the albuminous 
substance in the urine when the skin and kidneys do not re- 
move it, and the epithelial scales in desquamation, anasarcous 
urine, etc., no one need for a moment be troubled in making 
out a diagnosis. 

Treatment : Chlorate of potassa, diaphoretics and diuretics, 
with alkaline and stimulating baths, and washes or gargles of 



Urino-Pathology. 153 



chloride of zinc in weak solution; when the throat is sore 
internally, place a mustard application to the throat. 

We use a solution of chlorate of potassa internally during 
the whole progress of the disease, with tonics, when indicated. 
The sesquicarbonate of ammonia has lately been much extolled 
by medical writers, as having a specific therapeutic effect upon 
the special blood-poison of scarlet fever, neutralizing the so- 
called materis morbi; as also producing favorable results in 
the anasarca so frequently following, by its diaphoretic action 
in, "relieving the kidneys of the undue action they would 
have to perform in eliminating this blood-poison through the 
urine." Dose, from five to ten grains according to age ; also 
use as a gargle with from two drachms to six ounces of water. 



MEASLES, 



This disease, although not denominated a fever, like the 
preceding one, yet it might lay claim to that appellation with 
equal propriety, as it is as similar in its relations, as to cause 
and effect, as is scarlet fever to the other idiopathic fevers. 
This is, however, essentially an eruptive disease, and as such, 
follows, with propriety, scarlatina. 

Notwithstanding the similarity of the ushering in of these 
two disease, both being propagated by a peculiar poison, and 
both affecting the skin, in a peculiar manner, yet a marked 
difference in the blood and secretions is manifest, both dur- 
ing the disease, as also in the sequela. 

Like scarlatina, this is essentially a disease of childhood, 
rarely affecting persons of adult age, and seems to be caused 
by the introduction into the blood, of a virus peculiar to itself, 
and is both epidemic and infectious. 

It may be regarded as a disease of an inflammatory type, from 
the blood always exhibiting an excess of fibrin, and also, of a 
catarrhal character, from the urine, in the forming stage, al- 
ways exhibiting the fresh-beer-like bubbles of carbonic acid. 

Schonlein considers measles to be the most-highly-developed 
form of catarrhal disease, and says that the urine changes with 
the varying stages of the disorder. In most cases it more or 
less resembles the inflammatory type ; it is red (as in inflam- 
matory measles); acid; and sometimes turbid, as in gastric 
measles; or deposits a mucous sediment during the course of 
the morning, (as in catarrhal measles). 

Becquerel states, as the result of his observations, that the 
urine is generally inflammatory at the commencement of the 
febrile period ; that it becomes very dark, and of high specific 
gravity, and frequently deposits a sediment of uric acid. 

During the eruptive period, the character of the urine 
changes. If the eruption is slight, and there is not much fever, 



Urino-Pathology. 155 



it resumes the normal standard ; if the contrary is the case, 
the urine retains the inflammatory appearance. And during 
the period of desquamation and convalescence, the urine either 
returns at once to the normal state, or continues turbid and 
sedimentary for some time ; or becomes pale, clear, and anemic, 
according to the termination of the disease. The urine never 
becomes albuminous, like in scarlet fever, nor is measles likely 
to terminate in dropsy. 

The above characteristics indicate pretty well the appear- 
ance of the urine and its different stages, according to the dif- 
ferent stages of the disease in question. 

The urine will always be found acid to test-paper, of high 
specific gravity ; highly colored, and to contain crystals of uric 
acid. 

With the knowledge of the age of the patient, to begin 
with, and urine with the above conspicuously-marked charac- 
teristics and qualities, we may very readily recognize the 
disease even where the patient is not present. 

Treatment : Diaphoretics, stimulants and alkaline diuretics. 



SMALL-POX. 



This is a disease of an infectious and contagious character, 
and attacks alike the old and the young. It is also propaga- 
ted by a peculiar poison in the blood, and manifests itself upon 
the tegumentary investment of the body, aad therefore is an 
eruptive disease. 

That this disease is one of the blood no one doubts, inocu- 
lation and vaccination having settled the point. 

The blood, however, in this disease not only exhibits the 
usual marks of inflammation, but the peculiar matters which 
form the striking difference between it and every other disease, 
to-wit: the morbific virus itself; a purulent, mucous-like sub- 
stance, not to be found in the blood in any other complaint. 

With these facts before us, upon which we need not farther 
descant, we can easily anticipate the probable character of the 
urine. And, for the support of our own views, as we have thus 
done throughout this work, we will continue to supply evi- 
dence from every source of good authority, preferring quota- 
tions from these, to our 01*1 statements, whenever they con- 
tain the same opinions or facts. 

It is remarked by Simon that the urinary secretion in vari- 
ola undergoes changes, having relation to the various stages of 
the disease ; that in the beginning, when the fever assumes the 
character of synocha, the urine is eliminated in quantity, and 
increased in specific gravity ; that its color is deep and red, 
is frequently turbid, and often contains a small quantity of 
albumen. 

We have often seen the urine, in the commencement of 
small-pox, and before there was any appearance of the erup- 
tion, so highly colored as to resemble bloody water. 

In the eruptive stage, or when the eruption has more fully 
appeared, it becomes turbid and frequently throws down uric 



Urino-Patliology. 157 



acid precipitates, either spontaneously or by the addition of 
nitric acid, and sometimes a little albumen, and even pus. 

According to Schonlein, in the first stage of variola, the 
urine is of a reddish-brown tint; on the third or fourth day, a 
sweat of a peculiar and strong odor is observed, and the urine 
contains a turbid, and apparently purulent-mucous sediment, 
of an unpleasant odor. 

During the suppurative stage of variola, Becquerel observed 
that the urine retained the synochal character as long as these 
symptoms continued ; and in cases in which this fever persisted 
until death, the state of the urine always remained the same. 

During the period of desquamation the urine is either normal 
or anemic, (generally the latter). In the putrid stage of 
variola the urine appears decomposed, ammoniacal, and not 
unfrequently of a dark-red color, from the presence of hema- 
tin. In the nervous form or stage of this disease the urine is 
pale and limpid. 

To sum up, then, you will find the urine to be, in the form- 
ing stage, highly colored, bearing the general characters of 
inflammation, and perhaps reddened with blood. In the erup- 
tive stage, it soon becomes turbid on exposure to air, and 
apparently contains a muco-purulent substance, and deposits 
uric acid crystals, and in the last stage, dark and muddy, 
with disagreeably strong odor. 

Treatment : Allay the febrile excitement first, then give 
diaphoretics and stimulants, and finally, tonics. Keep the 
kidneys free with digitalis or other diuretics. 

"An Indian remedy for variola'' has been published in 
the Medical and Surgical Reporter, called u Sarracenia pur- 
purea" or pitcher-plant. A wincglassful of the infusion of 
the root, it is said, brings out the eruption in those under 
the influence of the disease ; a second or third dose, at inter- 
vals of four or six hours, causes the pustules to subside, 
apparently losing their vitality. If the patient is already 
covered with the eruption, a. dose or two will dissipate it. 
The urine, from being scanty and high-colored, becomes pale 



158 Urino-Pathology. 



and abundant; and in a few days the prominent symptoms 
subside, and no marks are left upon the skin. The remedy 
is used in the Indian camps to keep the antidote in the blood, 
and thereby act as a prophylactic. 



ERYSIPELAS. 



This is emphatically a disease of the blood, and one, the 
peculiarities of which are so striking and the danger in which 
is so great, as at once to convince us of the putrefactive 
tendencies of that fluid. 

There can be no doubt as to its infectious character, as the 
experience of nearly all medical men has shown. That it is 
nearly allied in its nature to that state of the blood which 
produces puerperal fever in lying-in-women, is also fully estab- 
lished, from the frequent communication of that disease to 
patients of that class, as also, from children of puerperal 
patients being so frequently attacked with erysipelas. 

An analysis of the blood shows an increase of the propor- 
tion of its fibrin, and a decrease in the number of its cor- 
puscles. In this fact, will be found one reason for the 
tendency to the speedy and fatal terminations of this malady. 
The blood, in this disease, is poor in quality, and unable to 
resist the action or influence of the large quantity of foreign 
or morbific matters with which it is highly charged at the 
time ; these are generally matters more properly belonging 
to the excretions, such as bile-pigment, nitrogen, etc., to- 
gether sometimes with pus-globules, etc. 

Andral and Gavarret found the blood in ordinary erysipelas 
so rich in fibrin, and its corpuscles so reduced in quantity, as 
to leave no doubt of its inflammatory character. 

Schonlcin states, that in this disease the serum is always 
tinged yellow by the coloring matter of the bile; that the 
proportion of scrum to tho clot is large ; and that the consist- 
ence is inversely as its size. The quantity of fibrin generally 
rises to six or seven parts in one thousand of blood, three 
being the average in normality. 



160 Urino-Pathology. 



Simon observes, that in the early stage of erysipelas the 
urine puts on the inflammatory character. "It is frequently," 
Schonlein remarks, " loaded with bile-pigment, and is of a 
reddish-brown or very red color. At the urinary crisis, fawn- 
colored precipitates are deposited, and the urine becomes 
clear." 

"Becquerel made two quantitative analyses of the urine 
of a man thirty-nine years of age, who had erysipelas of the 
face, and a good deal of fever, his pulse being one hundred 
and twelve. The urine of the first analysis was of a deep 
yellowish-red color, and clear ; its specific gravity was 
one thousand and twenty-one. That of the second was so 
deeply colored as to appear almost black ; it threw down a 
reddish sediment of uric acid, and had a specific gravity of 
one thousand and twenty-three. 

In a woman, aged forty-five years, who had erysipelas of 
the face, whose pulse was one hundred and four and full, 
the urine was very scanty, of a dark brown color, strongly 
acid ; it threw down a yellow sediment, spontaneously, and 
had a specific gravity of one thousand and twenty-three. 

In five cases, in which the morning urine was daily ex- 
amined with care, the characters of inflammation were present 
in a very high degree ; the specific gravity varied from one 
thousand and twenty-one to one thousand and twenty-five. 
In four of these cases the urine threw down a reddish sedi- 
ment, and in two, a little albumen was present. (Wilson). 

In a majority of cases, at least, the urine will be of high 
specific gravity, acid to test-paper, will contain uric acid 
in abundance, and in bad cases, bile-pigment; in very bad 
cases, pus-globules, mixed with albumen, the urine changing 
from bright-red to dark-brown, black or muddy, in regular 
gradation. 

Treatment : The treatment which seems to have been most 
favorably mentioned is that required for inflammatory dis- 
eases, in the first place ; give stimulants and diuretics in 
the second, and tonics and stimulants in the third, with 
emollient poultices. 



SHINGLES— (Herpes Zoster). 



This is an eruptive disease, in which there is considerable 
of a change manifested in the blood, its general properties 
being so far altered from the natural standard as to produce 
considerable alteration in the character of the urine, accord- 
ing to the following authorities : 

" The urinary secretion in herpes zoster," says Wilson, "has 
been made the subject of chemical examination by Muller. 

" In one case, that of a boy eight years of age, the urine 
was abundant, faintly alkaline, pale-yellow, rather turbid ; it 
rapidly became putrid, and deposited crystals of ammoniaco- 
magnesian phosphates ; its specific gravity was from one thou- 
sand and fourteen to one thousand and fifteen. 

" In the case of a young man aged nineteen years, the 
urine was clear, became turbid in the course of twelve hours, 
and deposited crystals of ammoniaco-magnesian phosphates ; 
its specific gravity was one thousand and eighteen. 

" In the case of a man thirty-one years of age, in whom 
there was slight fever, the urinary secretion was suppressed ; 
that which was examined being the first that had passed for 
twenty-four hours. It was strongly alkaline, deposited a sedi- 
ment of ammoniaco-magnesian phosphates, and urate of am- 
monia ; its specific gravity was one thousand and twenty- 
eight." 

The deductions resulting from the analyses of those three 
cases are," says the same author, "that there is: 1st, A 
marked increase of the chlorides and phosphates, and a cor- 
responding diminution of the sulphates ; 2d, An excess of 
hydrochlorate of ammonia ; 3d, A large amount of fat ; 4th, 
A diminution in the amount of uric acid, an increase only 
occurring when the disease is accompanied with fever — the 
presence of oxalate of lime may be suspected in these cases." 



162 Urino-Pathology. 



What more-marked indicatious of a disease would be re- 
quired, to determine any case, than is given in the above ? 
We need not add to the present, any experiments of our 
own ; let the incredulous but examine for themselves, and 
they will learn that even the simplest disease makes its mark 
upon the blood, and correspondingly upon the urine. 

Treatment : Sulphur, sulphuric and other acids, cream- 
tartar, vegetable diet, nitro-muriatic or sulphuric-acid baths ; 
or sponge-baths, with sulphur and acids — the acids being suffi- 
ciently diluted. 



PEMPHIGUS— (Vesicular Fever). 



Even this extremely rare disease so fully makes its own 
mark upon the blood, or is so completely manifested therein, 
that the urine being secreted therefrom has its well-marked 
difference exhibited also. For the facts in the case, we pre- 
sent the opinions of learned men, where their views will coin- 
cide with our own experience. 

The urine analyzed by Heller, in a case of severe pem- 
phigus, which proved fatal, the patient being a woman forty 
years of age, was acid, and its specific gravity one thousand 
and seventeen ; it deposited a light, cloudy sediment of mu- 
cus, with fat-globules, urate of ammonia and epithelial scales. 
Of the fixed salts the earthy phosphates were normal, the sul- 
phates much increased, and the chloride of sodium propor- 
tionably diminished. The urea was considerably above the 
normal average. 

In the case of a little boy, affected with acute pemphigus, 
Dr. M. Wilson found the urine painfully acid, of light color, 
depositing a light, floculent cloud, containing minute crystals 
of oxalate of lime, and loaded with urea. 

For the examination of these kinds of deposits, we can not 
too highly recommend the use of the microscope. In fact, 
it should be the constant accompaniment of all investiga- 
tions, chemical or otherwise. 

Treatment : Alkaline remedies, diuretic tonics, neutralizing 
mixtures and soda drinks. 



SCORBUTUS 



This, although not generally ranked among eruptive dis- 
eases, yet because of the ecchymosed condition of the skin, 
it may lay some claim to a place here, closely following shin- 
gles, pemphigus, etc. 

" The humoral pathologists," says Foltz, " in placing the 
primary seat of this disease in the changed condition of the 
blood, come nearest, in our opinion, to a correct view of the 
pathology of this disease." 

The most careful analyses of the blood in this disease have 
shown that it is one of poverty of that fluid ; that the amount 
of fibrin and corpuscles are always diminished, while the pro- 
portion of water is greater than in the healthy state. 

Dr. Foltz, Surgeon of the United States Ship Bariton, 
says : " The whole condition of the scorbutic patients clearly 
proves that morbifiic actions are going on in the blood. The 
extensive ecchymosis, purpural and petechial, the rapid ten- 
dency to ulceration in all parts of the body ; the diminished 
quantity, high color, and tendency to speedy decomposition of 
the urine, all evince that the blood is the seat of the patho- 
logical changes going on." 

The blood in this disease has been found to contain an 
excess of the chlorides of soda and of potassa, amounting to 
one-fourth part above their normal standard proportion. 

" Scurvy is a disease," says Dr. Beach, " which evidently 
arises from a depraved state of the blood." The pecliarity 
of this depraved blood being a diminished proportion of fibrin 
and corpuscles, and an excess of the chlorides of soda and 
potassa, we will necessarily look for a corresponding change 
in the constituents of the urine, and find such to be the 
case. 



Urino-Patholoyy. 165 



Dr. Fauvel, whose analyses of the blood in scorbutus seemed 
to differ from the above, although his cases were of quite aged 
persons, which might make some difference, asserts, in proof 
of his cases being genuine scorbutus, that " although there was 
a yellowish color of the entire skin, the urine giving no traces 
of coloring matter, proved it was not icterus, which it so 
much resembled," but true scorbutus. He was enabled to 
tell only by an examination of the urine, the true nature of 
the disease ; or rather, the urinary secretiou was made the 
test-indication or proof-mark. 

Protein is the basis of albumen, fibrin and casein, and 
these are the commencing or starting-points of all the tis- 
sues of the body. The products of highly-proteinized vege- 
tables are identical with the constituents of the blood, and 
when these principles are wanting in the food, as in the case 
of seamen and others who are deprived of vegetables for any 
considerable length of time, scurvy or poverty of the blood is 
the consequence, because nutrition has been arrested. Hence 
the blood in scurvy is found to be deficient in fibrin and cor- 
puscles, with an excess of water and the chlorides before men- 
tioned. And this condition of the blood yields to the urin- 
ary secretion the constituents of which reveal the true nature 
of the disease, and at the same time, according to Foltz, 
" furnish us with the means to guard against it, and to 
effectually remove it, after it does occur. 

The urine is scanty and high-colored, but the coloring 
matter is different entirely from that of the inflammatory 
type of diseases, being of a more dull-reddish, iron-rust color, 
the coloring matter being that of the iron carried out from the 
corpuscles. 

It is alkaline to test-paper, and deposits on cooling, a sed- 
iment of ammoniaco-magnesian phosphates, and sometimes 
urate' of ammonia, the product from the excess of soda and 
potassa in the blood. 

When these are found in urine of heavy color, like that of 
iron-rust, without the usual marks of inflammation, we will 



166 Urino-Pathology. 



have no difficulty in determining it to be a case of scorbutus, 
the remedies for which, the long-boasted specifics, lemon-juice, 
citric, tartaric, and acetic acids, together with acidulated 
drinks and vegetable diet, proves but the correctnes of the 
theory, they being effectual in nearly every instance, in chang- 
ing the condition of the blood, and altering the constituents 
of the urine pro rata — the natural operation of a scientific 
principle, showing the harmony and simplicity of all the oper- 
ations of nature. 



SCROFULA. 



This disease follows in order here, not because it may 
be classed as eruptive, but because of its being somewhat 
allied, the tendency of many eruptive ones being toward the 
development of the distinctive characteristic of scrofula. 

The scrofulous diathesis, as it is called, declares itself under 
a variety of cutaneous eruptions on the scalp, the eyelids, the 
nose, ulcers, etc., but until the occurrence of tubercle, the sure 
sign of its development, it is not considered to have reached 
this class. 

Scrofula is occasioned by a perverted or unhealthy develop- 
ment of the nutritive materials, destined for the repair of the 
body and the restoration of the blood, and consists, accord- 
ing to Simon, in a peculiarity of blood-development, under 
which the nascent blood tends to molecular death by super- 
oxydation. 

According to Dr. Williams, the tubercular diathesis is a 
degraded condition of the nutritive material, from which the 
old textures are removed and the new ones formed, and differs 
from fibrin or coagulable lymph, not in kind, but in degree of 
vitality and capacity of organization. 

The tubercular diathesis has a wide range of development 
and may appear in the form of glandular affections, carries 
off bones, cancerous affections, affections of mucous surfaces, 
etc. However much these affections may seemingly differ, 
the general conditions of the blood are similar, a partial 
change only being produced by local development ; hence, 
we have tubercles of the lungs, tubercles of the liver, bron- 
chia, or cancerous tubercles ; or scrofula, consumption, bron- 
chitis, cancer, etc. Each of these conditions may be developed 
by the same surrounding influences, as that which would affect 



168 Urino-PatJiology. 



the lungs in one person might only affect the bronchise in 
another, and so on. 

The term anemia is applied to that condition of the sys- 
tem in which the predominant character is a deficiency of 
blood ; and in scrofula there is not only a deficiency in quan- 
tity, especially of the red globules, but there is generally a 
remarkable deterioration in quality. The red particles of the 
blood being always defective in scrofula, there is at the same 
time a deficiency of the fibrinous element. 

" In scrofulous affections," says Simon, " the blood is defi- 
cient in solid constituents, especially in fibrin and corpuscles ; 
the primary causes being probably due to a deficient forma- 
tion of chyle, and to the influence of a moist, unhealthy 
atmosphere." 

When examined under the microscope, some of the cor- 
puscles of the blood appear devoid of color at the edges only, 
and some are entirely colorless. It is also found to be de- 
ficient in the normal quantity of salts. 

And, accordingly, we find the urine to be generally below 
the natural standard in color, and above it in fibrinous charac- 
teristics. It also contains more of the water and some of the 
salts, especially of the phosphates of lime and soda, which are 
always found to be in excess in the urine of this disease. 

Therefore, in the examination of the urine of a scrofulous 
patient, having determined from the deficiency of color and 
normality of fibrin, the anemic state of the blood, the excess 
of lime and soda in the urine, together with the abnormal 
ingredients of the tubercles, or scrofulous pus itself, which, 
in such cases, is imparted to the urine, and which the micro- 
scope will fully reveal, we will have no difficulty in deciding 
as to the scrofulous character of any such specimen of 
urine. 

By a microscopic examination of the urine containing these 
tubercular deposits, we are not only enabled to determine the 
general scrofulous condition of the system, by their creta- 
ceous, calcareous, carbonaceous, pigmentary, nucleated, or can- 



Urino-Pathology. 169 



cerous formation, but to describe tbe particular development 
before mentioned, to-wit : whether from the lungs, liver, bones, 
or whatever tissues. 

"In the cretaceous and calcareous forms of tubercle," says 
Carpenter, " the corpuscles and granules are mixed with 
gritty, saline particles, of an irregular form and size. A 
tubercle from the lungs and bronchial glands is pure carbon 
or charcoal, and chemically indestructible." " The cells of 
a cancer are large," says the same author, " transparent and 
distinctly nucleated, and consequently, easily distinguished 
from the small, non-nucleated corpuscles of a tubercle." 

Crystals of cholesterine are sometimes found in the cre- 
taceous and cheesy varieties of tubercle, also irregular black 
masses of pigmentary matter. 

For a more minute and extended account of the micro- 
scopic examination of the different kinds of tuberculosis, refer 
to Smith's Appendix to "Carpenter on the Microscope." That 
author says : " By the aid of the microscope, the impositions 
so frequently practiced upon the physician, have been often 
detected. One of the most frequent of these attempts at 
deception consists in mixing various substances with the 
urine." 

Scrofulous tubercles are generally found to be molecular 
and the corpuscles are larger and rounder than tubercles 
from any other part, and therefore different from those of 
consumption, the bone variety, etc. 

" From some form of tubercle," says Newton, " scarcely 
an organ of the body is wholly exempt, and since the blood 
is the true source of the tubercular deposit, this^is not sur- 
prising." 

There^isja peculiar^substance ^resembling mucus, called 
cystine, sometimes,, apparent in the urine of scrofulous pa- 
tients, especially those of a hereditary character. " The path- 
ological character of this substance," says Bird, "is essentially 
connected with the excessive elimination of sulphur, every 
ounce of this substanco containing, more than two drachms 



170 Urino-Patliology. 



of this element." We have seen a six-ounce hottle of urine 
let fall hy repose, a sediment of cystine of the hight of half 
an inch. 

It is believed to be peculiar to scrofulous cases, and especially 
to those of a hereditary character. "In one family alone," 
says the same author, "several members were at the same time 
affected with cystine ; and one instance exists where it can 
be traced with tolerable certainty through three generations. 

The color of the urine is generally yellow, sometimes chang- 
ing to green or apple-green. Its odor is that of sweet-brier, 
or sometimes like that of putrid cabbage. On the evaporation 
of the urine, it crystalizes in the form of six-sided laminae, 
but sometimes under the microscope resembles little white- 
rosettes. ( See Chart, Fig. 9). 

Treatment : Alteratives combined with tonics. 



CONSUMPTION. 



-*-•-•-•-•— 



Op all the diseases afflicting the human family, the prev- 
alence and fatality of consumption demands the greatest study 
and attention of the physician. The mortality of this dis- 
ease has been set down at from one-fourth to one-fifth of 
the human race ; or, " out of a population of twelve millions, 
sixty thousand die annually. ( Beach). 

There is in this disease an impaired physical condition of 
the lungs, and a deposition, in the air-cells, of a cheese-like 
substance, of a yellowish-white color, the particles of which 
aggregate and form masses of variable size, called tubercle, 
which finally soften into a liquid-like pus. This matter is 
taken up by the absorbents, enters the circulation of the blood, 
and particles of it are carried out of the system through the 
medium of the kidneys, and may be detected in the urine by 
microscopic and other modes of examination. 

" The nature of this disease," says one writer, " is unques- 
tionably scrofulous, as we see it transmitted from parents to 
offspring, with almost the same regularity as other legacies." 

The blood in this disease is always unusually serous, its 
vitality therefore may be regarded as of a lower grade than 
natural, and is called anemic, while at the same time it may be 
thick and sizy, "containing the elementary principles of tu- 
bercle," says Beach. 

While there is an excess of water in the blood, as also this 
thick, sizy matter, there is at the same time, a deficiency of red 
corpuscles and an excess of the fibrinous element. The 
average natural proportion of red particles in healthy blood, 
it will be remembered, is about one hundred and twenty-seven 
parts in one thousand, and in this disease it is sometimes 
reduced to as low as twenty-seven parts. 



172 Urino-Pathology. 



TVhile this seems to be the case in scrofula also, we -will have 
to ascertain the other peculiarities which distinguish it from 
that disease, in order to arrive at its peculiar development. 
This is to be done by obtaining a knowledge of the charac- 
ter of the discharges proceeding from the locality upon which 
the disease has spent itself. 

The urine, then, coming from the blood in this watery state, 
of a sizy, yellowish and creamy condition, will partake more 
or less of These substances and charae:r-is::es. Xot only will 
it partake more or less of these substances, bur of those which 
are taken in as food, drink, etc.. destined for the formation of 
blood-corpuscles, and which, by the peculiarity of the disease, 
are continually refused, as well as those which had already 
been formed in the vigor of life and are now being cast off. 
These substances will all be imparted to the urine, in the pro- 
portion of their abnormality in the blood, in the one case, 
and the refusal of their acceptance in another. 

Therefore, as is always the case in this disease, the urine 
will be high-colored during the process of the removal of the 
red corpuscles, the color being of a peculiar crimson or cherry- 
red, and containing at the same time a portion of the sizy 
substance, which readily coagulates, forming a table in the 
center of the vessel, when a few drops of nitric acid are added. 

When the red corpuscles of the blood are nearly exhausted, 
by the progress of the disease, the patient all the while becom- 
ing more exhausted also, the color of the urine becomes lighter, 
more straw-colored, and finally clear, as extreme debility comes 
on; but all the while maintains the peculiar character of coag- 
ulation in the center, as before mentioned. 

By this change in the color of the urine, and an increase of 
the coagulable substance in the tabular form mentioned, a pro- 
gression of the disease is certainly indicated. "When, on the 
contrary, if the urine assumes a more natural amber-color, with 
less, or a thinner table of coagula in the center, on appli- 
cation of the nitric-acid test, improvement in the case may be 
decided on. 



Urino-Pathology. 173 



Let me here remark, that this improvement has been more 
uniformly effected by the administration of the sirup of iodide 
of iron, than any medicine we have ever given. 

The chemical composition of the urine in consumption, shows 
an excess of the coloring matters, and of the phosphate of lime 
and soda, the result of non-assimilation and non-retention of 
those substances in the system, and traces of the peculiar 
tuberculous matter, to- wit: the " chemically indestructible 
matter of carbon, or charcoal." Tubercle from any other part 
of the system, be it remembered, is more easily destroyed by 
the action of alcohol or the mineral acids. They all vary in 
chemical composition, according to the location from which 
they are derived. 

For microscopic examination, set the vessel of urine aside 
to cool. If a cloud be deposited in the bottom, pour off the 
supernatant fluid, place a drop of the deposit on a glass plate, 
evaporate to dryness and place it under the object-glass, when 
the nucleated, granulated, calcareous or carbonaceous appear- 
ances will be easily detected; and these give evidence of the 
nature of the disease, by the location from whence derived. 
No disease is more easily determined by an examination of 
the urine, than is consumption. 

Before concluding we will present the views of A. P. 
Ducher, M. D., on phthisis pulmonalis : 

Let us now briefly consider whether there is any peculi- 
arity of urine characteristic of phthisis. If so, what does it 
consist in? We know perfectly well, that the great work of 
the kidneys is to separate from the blood certain nitrogeneous 
materials which are no longer fit for circulation. From the 
investigations of several experimentors, it appears that a cer- 
tain relative proportion of uric acid, is essential to a healthy 
state. Now in phthisis, this is disturbed, as the tables of the 
different experimentors will show : We believe it may be stated, 
as a general rule, that whenever from any cause, rapid waste 
of the system is proceeding, an excess of uric acid will be found 



174 " Vrino-Pathology. 



in the urine. Such is always the case in phthisis, when it is 
not complicated with kidney disease. 

But the chief characteristic of the urine in this disease, is 
the production called eurerythrin. This is a beautiful carmine 
precipitate, and is easily detected by the addition of ammonia 
to the urine that contains it ; it is seldom found in any other 
disease. We may generally suspect suppurative cavities in 
the lungs when this sediment appears in the urine. 

In the first stages of phthisis, the specific gravity of the 
urine is very little below the natural standard, but in the last 
stage, it assumes what may be called anemic urine, presenting 
a pale aspect, without sediment and of very low specific 
gravity. If these conditions of the urine be kept constantly 
in view, they will, without doubt, at times, be of great service 
in making out a clear diagonisis of this disease. 

Dr. Churchhill, who obtained notoriety by his discovery 
of the cure of consumption, by hypophosphites of iron, lime, 
and of soda, says: "All we can reasonably ask is, that the 
treatment should dissipate the diathesis" which is very good. 
But furnishing the food to a disordered stomach will not alone 
feed the body; and in the treatment of this disease there is 
as much need of preparing the sanguiferous system for the 
reception of the blood-food, by the removal of the cause, as 
there is in fitting the dyspeptic stomach for digestion. 



DROPSY. 



The term dropsy signifies a morbid accumulation of water 
or serous fluid in the cellular tissue or serous cavities. It 
depends upon a loss of vitality of the nervous energy, of the 
capillary exhalents of the blood-vessels, together with a de- 
ficiency of what is supposed to be iron, and some other con- 
stituents of the blood. 

Like scrofula, consumption, and other anemic diseases, it is 
one of debility of the blood, the most general cause of which 
appears to be a special difficulty existing either in a func- 
tional or organic affection of the kidneys. " This," says Dr. 
Beach, " has always appeared to me to be the great first- 
cause of dropsical effusion, and it has of late years been 
confirmed by the researches of Dr. Bright, of London." 

Now, if it be even true that the most general cause of 
dropsy arises from a special difficulty in the kidneys, there 
are varieties of this disease that are complicated at least, 
with affections of other organs, such as of the liver, spleen, 
stomach, heart, and even of the generative organs, and to 
determine these complications is a desideratum — to be obtained 
many times only by an examination of the urine. 

When the urir$ of dropsy throws down copious lateritious 
or fawn-colored sediments, as in disease of the liver, or is 
colored with bile, as in jaundice, or appears of a dark-red or 
brown color, without sediment, as when complicated with dis- 
organization of the female generative organs ; or when it con- 
tains blood, as in some pneumonic affections, these various 
peculiarities added to those which arise solely from disease 
of the kidneys, or from that which is characterized as drop- 
sical urine, will enable us to determine, if not the cause, the 
complication, at least, and hence will give a clue to the proper 
treatment. 



176 Urine-Pathology. 



By whatever combined influence dropsy may ensue, the 
blood first partakes of these influences, and; imparts the char- 
acteristic particles to the urine. 

"The blood," says Beach, "is unhealthy in dropsy; serum 
or water, of course, greatly preponderates. Owing to the de- 
ficiency of albumen, the blood is pale-colored ; it sometimes 
contains urea in large quantities. Albumen, fibrin and the 
red particles, which constitute the great bulk of the matters 
existing in the blood, are never met with in healthy urine ; 
but in some varieties of dropsy and other diseases, the urine 
not only contains the serum of the blood, but the fibrin and 
red particles likewise pass through the kidneys unchanged." 

" It appears, therefore, from what has been said, that the 
contents of the urine and of the dropsical fluid in this dis- 
ease, bear to each other a certain definite relation. For ex- 
ample : the water which ought to be discharged in the form 
of urine, passes out in the form of dropsical fluid, and is 
not retained in the blood (but is found in the tissues or cav- 
ities), and the albumen, which is deficient in the blood, is 
found largely in the urine, scarcely at at all in the dropsical 
fluid, while the salts which are wanting in the urine, are found 
entirely in the dropsical fluid, none of those which ought to 
have been secreted with the urine being retained in the 
blood." 

In the elegant extract above, we have the whole matter 
before us, in which we can see at a glance the pathology of 
the disease, to-wit : disease of the kidneys, the anemic con- 
dition of the blood ( deficiency of albumen, fibrin and iron ) , 
with a large increase of albumen, etc., in the urine ; as also 
may be seen the symptomotology of the disease, and a very 
good clue to its treatment is obtained. 

There are several stages, however, of this disease to be 
recognized clearly, in the examination of the urine, in each 
of which, it changes in color, as well as chemical qualities, 
all partaking, however, of the same general characterist ics be- 
fore mentioned. 



Urino-Pathology. 177 



The first of these is that of congestion, in which the urine, 
loaded with albumen, etc., will be reddish, highly colored with 
the red particles of blood, and acid to test-paper. 

In the second or more chronic stage, the urine will be paler, 
of a light-yellow color, and turbid, depositing more or less a 
brownish sediment, with acid. 

In the third stage, the urine will be of a deep-red color, 
containing more or less of blood, the consequence of weak- 
ened blood-vessels, and will deposit a red or reddish-brown 
sediment. 

" The urine in this disease," says Beach, " is almost always 
very acid, which fact must be kept in view in making out a 
diagnosis." 

The urine, whether in dropsy of the head, chest, or abdo- 
men, will exhibit the same general characteristics, modified 
or altered only by the local cause or affection coexisting. 

Albumen will be found to enter largely into the ingredients 
composing urine from a dropsical patient, the quantity cor- 
responding with the extent of the disease. This may be de- 
termined in the usual way, to-wit : producing coagulation by 
nitric acid and the application of heat, both of which are 
necessary to a surety, the heat giving the urine the appear- 
ance of curdled-milk. 

The blood in the urine may nearly always be known by 
the dingy color it imparts to that fluid, or by tests, or micro- 
scopic examination. 

If the dropsy does not proceed from a faulty action of the 
kidneys, whereby the blood has thus become deranged in its 
constituents, or if it is connected with the deranged condition 
of other organs, another condition of urine will be added. 

" If the sediment in the urine is of a pink-color, it will 
always denote a scirrhus state of the liver," says Cullen. " In 
the diseased liver, the pink-deposits are almost constantly 
present in the urine, " says Bird, " and we think we have 
received some assistance in the diagnosis between dropsy de- 
pending upon hepatic and peritoneal disease, in the presence 



178 Urino-Pathology. 



of pink-deposits in the former, and their general absence in 
the latter." 

The urine in dropsy will also be found deficient in the quan- 
tity of salts common to the healthy standard of that fluid, the 
consequence, as before observed, of their deposit with the drop- 
sical fluid in the cavities. 

These salts, chloride of sodium, potassa, lime, magnesia, etc., 
in health, generally constitute about fourteen parts in one 
thousand of that fluid, while in this disease almost their entire 
absence is noted: this state will be discovered most readily by 
the microscope. The evaporation of a small quantity of urine 
on a slip of glass, placed under an object glass, will readily 
enable one to tell, by comparison, very nearly the proportion 
of chloride of sodium, by the quantity of dagger-shaped or 
crosslet-crystals, etc., and of the other salts. 

Treatment : In all cases of dropsy of the chest or abdomen, 
the warm, alkaline-bath, with bandage or compression of the 
swelled parts, seem to favor the evacuation of the fluid, and 
assist the action of the medicine in removing the accumulated 
salts, and in retaining the albuminous substance by supporting 
the weakened blood-vessels of the part. 

Where albuminous urine is strongly presented, digitalis, in 
decoction, seems to be indispensable, and will frequently relieve 
the urgent symptoms in a short time. The use of this should 
be followed by tonics and astringent diuretics, uva ursi, buchu, 
and pipsissiwa in tea or decoction. If disease of the liver is 
connected with it, podophyllin, leptandrin, and iodide of 
potassa should be used, with perhaps cream-tartar, elate- 
rium, etc. 



DROPSY — (After Scarlatina). 



" The different conditions of the urinary discharge," says 
Blackall, " seem to indicate a corresponding difference in the 
constitutional affection to which they belong ; and we entertain 
hopes, that hereafter, and under a more accumulated experi- 
ence, they may be found important guides to practice." 

This is precisely the object of this work, to collect the expe- 
rience of others, which when added to that of our own, may be 
found to be a guide to practice. Hence our reason in part for 
such free use of the labors of others, in the many quotations to 
to be noticed throughout its pages. 

In dropsy following scarlet fever, the blood is found to 
present the same general characteristics as in other dropsical 
swellings, to-wit: a deficiency of albumen, iron, or red corpus- 
cles, etc., a preponderance of serum, and its pale-colored and 
anemic appearance generally. 

The urine, therefore, will of course take on the usual char- 
acteristics of dropsy. The same excess of albumen and 
deficiency of salts being apparent in the same relative propor- 
tion, according to the extent of disease, bearing in mind the 
age of the patient. 

In the treatment of this disease, the facts respecting the rela- 
tive conditions of the blood and urine going hand-in-hand, are 
only the more fully established. 

Dr. Bird says : "The disappearance of albumen in the urine 
and the presence of uric acid, become valuable indications of 
convalescence;" while Dr. Blackall gives the most convincing 
proofs, that dropsy, after scarlatina, can be removed only by 
unloading the urine of the scrum of the blood, or of its albu- 
men, and says, that an improvement in the state of the urino 
will be among the first and most convincing signs of an 
improvement Jn the health of the patient. 



180 TJrinO'Pathology. 



His main dependence in the treatment of such dropsies, is, 
upon unloading the urine of its albuminous quality with digi- 
talis ; and if bloody sediment is at any time observed in the 
urine (which he thinks is generally hastened and encouraged by 
the use of mercury), he recommends the use of Peruvian-bark 
and vrine, but in all cases to ascertain the exact character of 
the urinary discharge before employing medicine. 

Our own experience and observation in this disease, which 
we believe to be often the effect of improper treatment and bad 
nursing of the fever, has led us to form a high estimate of 
diuretics generally, in connection with diaphoretics and sudo- 
rifics. If the treatment, indicated in this work for scarlet 
fever, be rightly adopted and carried out, there will scarcely 
ever be need for any afterward. 

The warm-bath in these cases has a most beneficial effect, 
and digitalis is a most excellent remedy in connection. The 
sesquicarbonate of ammonia, as recommended in scarlet fever, 
may also be good. Dandelion, queen-of-the-meadow, horse- 
radish and juniper-berries, are among.^the vegetable remedies 
recommended; while acetate of potassa, nitrate of potassa, 
cream-tartar, etc., are many times used. 



HYDROTHOBAX. 



In this disease, like the preceding one, there being the 
same general conditions of the blood, and correspondingly of 
the urine, there will not be a great or material difference to 
note in the case. Nor does it at all make any very material 
difference, since the condition of the blood and urine are the 
same or similar in each, the treatment, of course, should be 
similar ; the same indications to fulfil and the results to be 
effected will be best accomplished by the same medicines. 

There is, in fact, no very material difference in the char- 
acter of the whole list of dropsical diseases, only in so far 
as they may be dependent upon different causes, or compli- 
cated with different other affections, and therefore give rise 
to additional symptoms; thus, dropsy may be complicated with 
diseases of the heart, liver, lungs, kidneys, etc., in all of which 
the peculiarities of urine belonging to these affections will be 
superadded to it in this disease. 

There will be a difference in the external symptoms of 
dropsy, according to the locality of the disease, to wit : in 
hydrothorax there is difficulty of breathing, the consequence 
of invasion by the dropsical fluid upon the territory of the lungs ; 
in hydrocephalus, a violent pain in the head, consequent upon 
pressure of the brain, and so on. But the only facts really 
worth knowing for the purpose of treatment, are whether the 
fluid occupies the cellular tissue, or serous cavities, and what 
is the primary cause of the affection. These may bo deter- 
mined, first, by the locality of the fluid; second, by the signs 
of the affection of the organ ren in other plac 

The complications, which are many times presented in this 
way, are the most difficult to determine, because of tlu* obscu- 
rity which one throws around the other; this but increases 
the difficulty of a scientific treatment of an already difficult 



182 Urino-Patfiology. 



case. A correct knowledge of the peculiar cachectic state of 
the blood, however, to begin with, will very much enhance the 
prospects of a scientific treatment, and secure better chances 
of success. 

Similar treatment will be required in this as in other drop- 
sical cases, where there is no complication, and as it is not 
the province of this work to lay down definite and specific 
treatment of diseases, but rather to assist in diagnosing them, 
that which seems to be indicated merely will be mentioned, 
leaving the practitioner to select his own remedies and mode 
of applying them, in each particular case, according to his 
own good judgment. 

That which carries off the dropsical fluid, and prevents its 
re-accumulation, will give relief the quickest. Digitalis, dan- 
delion, queen-of-the-meadow, uva ursi, buchu, etc., with tonics 
and hydragogue cathartics, are indicated. 



HYDROCEPHALUS. 



This disease seldom attacks any but those of extreme 
youth; and while we have reason to believe that the same 
general characteristics govern it as those of other dropsies, 
owing to the difficulty of obtaining the urinary discharges from 
infant patients in a sufficient quantity and number of cases 
to fully test it, but little is positively known. 

It is in dentition, however, that the foundation of this dis- 
ease is most frequently laid, or it frequently follows as a se- 
quela, like anasarca after scarlatina, and like this latter, the 
improper or unsuccessful treatment of the one, most frequently 
follows the other. 

Dr. Simon says, that as long as the kidneys act freely there 
is little or no risk in the symptoms of mere dentition, how- 
ever severe and distressing these may be ; but if the urinary 
excretion is diminished or suspended, and this state of things 
is permitted to continue without relief, there is much risk of 
alarming cerebral symptoms quickly making their appearance. 
When the urinary secretion is scanty and deep-colored, the 
circulation seems to be both oppressed and excited ; and the 
rapid, in some cases almost instantaneous mitigation, after a 
copious discharge of water, is well known to all experienced 
practitioners. We would remark that as there is generally 
the complication of dentition in this disease, the treatment 
should vary in accordance. 



OYARIAN DROPSY, 



We do not place this disease in the category of the drop- 
sical ones from any resemblance it bears toward that class. 
In fact, it admits neither of the same explanation, nor sub- 
mits to the same remedies as apply to diseases of the serous 
membranes. But, like hydrocele, and other hydropic dis- 
eases, is to be viewed more in the light of an enlarged viscus 
than in diffused accumulations in the cavities. 

The blood in these cases is not generally represented by 
any very excessive deficiency of albumen, but rather a normal- 
ity in that respect, and although somewhat anemic, there is 
scarcely ever any albumen to be discovered in the urine, 
unless the tumor has attained considerable size. Therefore, 
the urine is not found to be distinguished by scarcely any 
dropsical qualities at all ; and in cases where the general 
health is not much impaired, very little change is discovered. 

Schonlein, however, says that in ovarian dropsy the urine is 
sometimes very scanty, and contains a considerable quantity 
of albumen, which increases in quantity as the disease ad- 
vances ; therefore, when the affection is considerable, the 
qualities peculiar to that viscus, also, may be represented 
therein in connection with the very anemic urine which is then 
presented. 

In whatever case, however, the treatment most beneficial 
seems to be that which meets best the indications of the urine. 
If anemic, tonics, iron and wine ; if scrofulas or cachectic, al- 
teratives and tonics ; if dropsical, digitalis and astringents ; 
cures are seldom performed by medicines, more seldom by 
operations. 



CHLOROSIS. 



The blood in chlorosis is generally deficient in fibrin, never 
above the normal standard in quantity, and it is said not to be 
so firm in consistence as in health ; and while the amount of 
fibrin may be normal even, the amount of corpuscles are 
always much diminished. And, as in most diseases, the phys- 
ical character and chemical constituents of the blood change 
during their progressive development, and are different in the 
incipient and in the fully-developed stages. Thus, as the 
disease is more fully developed, the fibrin becomes more and 
more diminished, as also the blood-corpuscles, and with this 
great diminution of these constituents, there is a larger and 
larger augmentation of the proportion of serum, until it is no 
longer capable of supporting its function. 

The urine of chlorotic persons is usually pale, of low spe- 
cific gravity, and resembles the urine of persons who have lost 
a considerable quantity of blood. Beckerel applies the term 
anemic to this form of urine, and as in a majority of cases in 
which it occurs, there is either an absolute deficiency of blood, 
or a scarcity of a truly vital portion (the blood-corpuscles), 
the term would seem appropriate. 

The urine in chlorosis has, however, other distinctive prop- 
erties. According to Beckerel, " it is very poor in urea," and 
from the intimate connection subsisting between the action of 
the metamorphosis of the blood-curpuscles on the one hand, 
and the production of urea on the other, this is not surprising, 
the absolute and relative diminution of the urea thus plainly 
indicating the cause of the disease being a want of the produc- 
tion of blood-corpuscles. 

In this disease there is a decided anemic condition of the 
blood, the red particles being reduced from the normal stand- 
ard proportion five hundred per cent., in some cases. 



186 Urino-Pathology. 



"Certain it is," says Dr. Ashwell, "that chlorosis prima- 
rily depends upon a morbid condition of the blood, which 
secondarily affects the ovaries and arteries by retarding their 
growth. 

This is supported by the fact, that in the blood of chlo- 
rotic patients there is an increased proportion of serum, with 
a marked diminution of crassamentum. And dissections of 
those who die with this disease, have generally shown the 
ovaries to be in a diseased or scirrhosed state. 

" The morbid character of the blood in chlorosis," says 
Beach, " must be ranked among the most convincing proofs of 
the truth of humoral pathology." 

There is many times a faulty state of the kidneys in connec- 
tion with this disease, in which case the albumen of the blood 
is generally early and freely carried off. In the first stages, 
therefore, the urine may contain considerable quantities of 
that substance, and it becomes paler, and contains less and 
less of the coloring matters of the blood, also, until its weak 
and limpid-water appearance scarcely exhibits any traces of 
the general qualities of urine at all. When the urine exhibits 
this appearance, the proportionate quantity of serum in the 
blood has become so great that it is said that a drop of the 
blood will scarcely stain white linen, and is very similar to thb 
blood of patients who have suffered excessive hemorrhage. 

The peculiarly clear, watery appearance of the urine, 
derived from this state of the blood, gives a clue to the 
appropriate treatment of the disease, that is well worthy of 
our consideration ; "a most grave error is too often com- 
mitted," says one author, "by considering it a local, and 
not a constitutional disease ; and ignorant practitioners, by 
the untimely use of drastic purgatives and emmenagogues, 
have yet farther reduced the already-enfeebled powers and 
facilitated the advent of pulmonary disease. 

Treatment : Mild cordials with aperients ; warm clothing, 
regular exercise, etc., with iron, hydrastis, nourishing diet, 
and saline-baths, with mustard hip-bath, etc. 



Urino-Pathology. 187 



The hypophosphites of lime, of iron, and of soda, if pure and 
perfectly prepared, might be of much benefit, if the stomach 
is in order to receive them. From the observations of Simon, 
as well as Arnold and Gavarret, the administration of ferru- 
ginous preparations are decidedly beneficial. The changes 
wrought in the blood thereby were truly surprising, the amount 
of solid constituents were increased nearly one-half, and the 
increase of hemato-globulin was likewise extraordinary, and 
the changes in the conditions of their patients kept pace with 
those changes of the blood. Small doses only of iron should 
be used, lest the digestive organs be interfered with. 



DIABETES. 



The pathology of this disease is very obscure, yet, what 
ever may be its origin, there is no doubt but its first mani- 
festations are in the altered condition of the blood. Like 
dropsy, however, which is in a measure its kindred disease, 
there is, generally, a deranged state of the kidneys with a 
deficient state of the urinary secretion. 

In the remarks of Areteus, in his chapter on the cure of 
diabetes, "he commences," says Blackall, "by stating that 
diabetes is a species of dropsy, both in its cause and in its 
general nature, and differs from it only in the channel 
by which the humors pass out of the circulation; that in 
dropsy they are deposited in the cavities of the body, in 
diabetes are carried off by the kidneys and bladder." He 
adds, that if relief is obtained in dropsy, it is by that chan- 
nel, namely, the urinary organs; but that this relief consists 
rather in the solution of the cause, than in the mere removal of 
the burthen. 

We all know that there are many states of the system in 
which, if the urine is increased in quantity, the body wastes, 
if lessened, it swells ; the one, therefore, constitutes a diabetic 
state, the other, a tendency to dropsy, and both are from a 
similar cachectic state of the blood. 

Much has been written and many ingenious theories have 
been devised to explain the manner in which the saccharine 
matters found in the urine are formed, and the process by 
which these elements are removed from the blood. "Without 
stopping to present these, we will proceed to the condition 
of the urine. 

The first and most prominent symptom in this disease is 
generally perceived by the discharge of a most extraordinary 
quantity of urine, sometimes averaging ten quarts in a day, 






Urino-Pathology. 189 



and some well-authenticated cases are on record, where 
from twenty to twenty-five quarts were discharged in twenty- 
four hours. Its weight, when the disease is fully established, 
exceeds that of the liquids drank. 

"It is saturated," says Beach, " with a saccharine matter, 
and is very sweet to the taste; an ounce of sugar has been 
extracted from a pound of urine." This peculiarity alone is 
sufficient to detect the nature of the disease. A great variety 
of plans, however, for testing this kind of urine have been 
presented, most of which are sufficiently accurate for practical 
purposes. 

The urine being thus excessive in quantity, largely sac- 
charine in quality, will be acid to test-paper; it will gener- 
ally be of a pale straw-color, and the odor that of new milk. 
When left standing for some time, it will become somewhat 
turbid, and soon undergo, spontaneously, what is called "alco- 
holic fermentation." 

" The most convenient means of ascertaining the presence 
of saccharine matter in diabetic urine," says Christison, "is to 
add to it some yeast, which gives rise to vinous fermentation, a 
most delicate test, as it can detect one part of it in a thou- 
sand parts of urine." Every cubic inch of gas given off, 
nearly corresponds in round numbers with one grain of sugar. 

"Another equally delicate test is the growth of torulae," 
(See Chart, Fig. 12). " These spores or fungoid vegetations 
make their appearance in the urine whenever saccharine matter 
is present in however minute proportion. Their true nature 
can be readily detected by the microscope." 

"Boil the suspected urine in a test-tube, with an excess of 
liquor-potassa, and if it contain sugar, it will assume an 
orange-yellow, or brown or claret-color, in proportion to the 
quantity present." (Moore). 

" If a drop of diabetic urine be diluted with ten drops, or 
even more of water, the presence of sugar will be 6hown by 
the above test." (Heller). 



190 Urino-Pathology. 



A great number of other tests are given by different authors, 
but enough has been said to enable anyone to decide with suffi- 
cient precision the nature of any case, which is the principle 
object of this work. 

Before concluding this subject, we would remark, that 
although there is a seeming similarity between dropsy and 
diabetes, respecting the anemic condition of the blood, yet a 
very material difference exists ; and from the very difference 
in the character of the urinary discharges, we must conclude 
that a different course of treatment will be requisite also. It 
seems that the kidneys are universally affected in this disease ; 
not so in dropsy. 

Treatment should be directed to the restoration of the kid- 
neys ; in connection — astringents, diuretics, tonics, and stimu- 
ants ; animal diet as much as possible, with attention to the 
skin, with warm clothing, etc. 



LIVER-COMPLAINT. 



It is well known that the liver is one of the most active 
organs in the animal economy. It is supplied with blood 
from both the hepatic artery and the vena porta. And, in 
addition to the change made by its action upon the blood, in 
the separation of bile, it affects still further changes upon the 
blood by drawing from that fluid the sources of its own nutri- 
tion. As the entire structure of an organ must necessarily 
correspond with its functions, with every variety of internal 
organization, there will be a corresponding variation in the 
secretion ; and any undue excitement of an organ increases 
its secretion, or its sedation diminishes it, so will we have 
it thrown upon the blood. In this disease there is a pecu- 
liar cachetic condition of the blood which gives rise to a long 
train of diversified symptoms. There is generally a derange- 
ment of the general or ordinary function of the liver, as well 
as structural affection ; and this derangement changes the 
quantity and quality of bile, which it is the office of the liver 
to secrete, and thereby, the blood also is changed. 

From what has been said in preceding pages on inflam- 
mation of the liver (which see), the great importance of this 
organ in the action of many diseases will be readily observed. 

In the more acute form or stage of this disease, carbon is 
more abundantly eliminated from the kidneys than in this, 
the chronic form, and the urine will bo more bright-colored 
in the former and more dingy in this Latter stage. The liver 
itself becomes structurally enlarged and unfit to perform its 
duty, when imperfectly formed bile will be thrown into the 
circulation of tho blood, become diffused throughout the gen- 
eral system, and taken up by the kidneys and discharged 
through the urine. The countenance becomes yellow, the 
eyes have a yellowish tinge, the whole skin becomes chan_ 



192 UrinO'Patliology. 



in color and appearance; and the urine takes on a brown- 
ish, or lastly, yellowish color, indicative of the presence of 
bile in that fluid, and on repose a brick-dust sediment is 
deposited. 

The appearance of the urine as also those other symptoms, 
however, will vary according to the degree of deviation from 
the natural appearance, or a healthy standard. It will be 
small in quantity, high-colored, of high specific gravity, and 
the brick-dust sediment will be bile-pigment. " Gall-pigment 
in the urine" says Simon, "is constantly a sign of the liver 
being affected." The more severe the case, the deeper the 
color and the heavier the sediment formed in the urine. In 
extremely bad cases the urine, after having undergone the 
appearances above mentioned, becomes still more dark and 
heavy, amounting to a heavy brown color, which upon repose 
becomes still darker even, assuming a blackish, or almost 
muddy-ink appearance This last, however, like that in the 
last stage of jaundice, to which it is allied, may be regarded 
as a hopeless case, the blood having become so far dissolved 
as to be beyond the power of human agency to restore it. 

The urine of chronic liver-complaint always contains another 
substance called purpurine. "The presence of an excess of 
this substance," says Bird, "is almost invariably connected 
with some functional or organic mischief, of the liver or spleen." 

This substance is distinguished by not being affected in 
color or transparency by a boiling heat, and may be detected 
by adding a little hydrochloric acid to some of the urine pre- 
viously warmed, when a color varying from lilac to purple im- 
mediately occurs. 

"In the malignantly diseased, in the contracted, hobnail, or 
cirrhosed liver," says Bird, "the pink-deposits are almost con- 
stantly present in the urine." These pink-deposits present the 
flesh-colored appearance in the urine, and are a common ac- 
companiment, in even slight derangement of the hepatic func- 
tion. 



Urino-Paihology. 193 



Bile is always present in this disease, and may readily be 
detected by the usual test. A mere ocular inspection of the 
urine in liver-complaint, is nearly always sufficient to deter- 
mine at least the nature of the case, and many times, to give 
a very correct opinion of the extent of the mischief also. 

Treatment : Hepatics and deobstruents are indicated. Podo- 
phyllin leptandrin, and taraxacum are the principal reme- 
dies to be relied on, and may be^combined to advantage. Al- 
teratives are sometimes beneficial,^ sarsaparilla, guiacum, stil- 
lingia, etc., and an irritating plaster over the region of the 
liver, with warm-baths, etc. An emetic, perhaps, to begin 
with, would be good treatment. 



JAUNDICE. 



From the fact that the preceding disease ( liver-complaint ) 
frequently manifests itself in the form of jaundice, or that 
icterus is most frequently the consequence of impeded pas- 
sage of bile into the bowels, or that because of this impeded 
passage, the bile is taken up by the absorbents and thrown 
into the circulation of the blood, jaundice is made manifest, 
a very similar effect to that produced upon the urine in liver- 
complaint, is to be expected in the urine in this affection. 

Accordingly, we find a great similarity existing in the urine 
in these two diseases, so far at least, as the biliary condition 
of that fluid is concerned. The coloring principle of the bile, 
at least, and in fact, the bile itself, so manifestly thrown into 
the circulation, thence out by the urine, makes every case of 
jaundice thereby so sufficiently marked as to enable anyone 
with the least experience, to diagnose the case correctly, upon 
a mere ocular inspection of the urine alone. In fact, no prac- 
titioner can have had much experience in this disease without 
being able, at a single glance of the urine, to determine at 
once the jaundiced condition of the patient ; as also, to de- 
cide very nearly the precise stage of the disease. 

In this, like in many other diseases, the state of the urine 
denotes the character of the affection long before it is mani- 
fested by any other symptom or more outward sign. The 
moment the blood begins to take on any of the constituents 
of bile, the kidneys begin to secrete it therefrom, and the 
urine to discharge it, more or less, according to the extent of 
the abnormality. 

Dr. Simon says : " In jaundice, whether it be idiopathic or 
symptomatic, the urine contains bile-pigment, which shows 
itself in the peculiar color which it communicates to that 
fluid." 



Urino-Pathology. 195 



The color of icteric urine may vary from a saffron-yellow 
to a yellowish-brown, brownish-red, or blackish-brown. In 
acute icterus, accompanied by fever, Schonlein found the urine 
at first of a dark-red or brown color, from the presence of 
bile-pigment ; it afterward became darker, and at last, as 
black as ink. 

Scherer mentions a case of long-standing icterus, dependent, 
apparently, on chronic inflammation of the liver, in which the 
urine on emission was clear, yellow, and perfectly neutral, 
but after standing a few hours, became acid, and deposited a 
large amount of bile-pigment, in a yellowish-brown mass, and 
in the course of twenty-four hours the yellow color of the 
urine became converted into a blackish-green. 

Prof. Eberle says he has not met with a single case of 
jaundice in which the urine did not acquire a bilious hue. 
And whatever may be the cause, all authors agree that there 
is a deposit of the coloring matter of the bile in the blood 
and tissues of the body, and that the same is observable in 
the urine. 

There is seldom any inflammatory indications in jaundice, 
therefore the first trace of coloring matter, even in the onset 
of the disease, may be detected by the usual nitric-acid test. 

In the more marked cases, the urine assumes a still more 
dark and bilious appearance from the greater excess of the 
same matter, and as the disease progresses to the more dan- 
gerous stage, the urine becomes more and more dark, even 
to a dark-brown or blackish appearance, because of the large 
amount of black bile or bile-pigment being carried out through 
that medium. And so regularly is this course in the disease 
marked by the urinary secretion, that every stage ran be pre- 
eminently diagnosed thereby. Ami so universally is the ex- 
tremity of the disease so darkly and swarthily marked, both 
in the skin and the urine, that what was at first called yeilow- 
jaundice, is now not inaptly called black jaundice, bj the 
common people, from which they believe " there is no hope 



196 Urino-Pathology. 



of recovery," and they are not very far wrong in their con- 
clusions. 

The urine in jaundice, however, generally differs somewhat 
from that of chronic liver-complaint in this, that the bile is 
of a more vitiated quality, and hence the urine is more tur- 
bid from the beginning, and in whatever stage, has a heavier 
and more muddy appearance than belongs to that of liver- 
complaint, and, as a general thing, gives out less of the car- 
bonaceous matters of the liver itself, or of particles from that 
organ. 

From these qualities we will have no difficulty in determin- 
ing the difference, and in correctly diagnosing an uncompli- 
cated case of jaundice, in whatever stage of the disease, by 
an examination of the urine alone. 

The coloring matter in the urine in a bilious case, is gen- 
erally called purpurine, which, by the addition of a little alco- 
hol to the deposit containing it, will produce a fine purple 
tincture, the purpurine being given up to the alcohol. 

Treatment : First give an emetic of Lobelin, as this is a 
most relaxing agent, then the following powders, two or three 
times a day : Three grains of podophyllin, twelve leptandrin, 
and twenty-four Dover's powder — divided into twenty-four 
papers. Take at the same time half a teaspoonful of tinc- 
ture sanguinaria in warm tea, before each meal, and one egg 
in brandy one hour aftereach meal. 

Alkaline remedies are highly recommended : pills made of 
Castile-soap and leptandrin might be used advantageously. 



DYSPEPSIA. 



All the internal parts of the animal body are covered 
by a soft, velvety, and highly vascular coat, called the mucous 
membrane. These surfaces secrete a viscid, stringy, and 
often tough fluid, somewhat different in character, according 
to the part secreting it ; and this secretion of mucus may be 
increased or diminished according as the part may be more or 
less affected ; as also it may assume anomalous characters, 
which unfit it for the purpose intended. Especially may that 
be the case with the gastric juice or the secretion of mucus 
from the stomach. 

The subject of digestion has attracted much attention, for 
a great number of years, and yet but little seems to be known 
with certainty, relative to the modification the food under- 
goes in the stomach and alimentary canal, but more espe- 
cially the anomalous characters that are sometimes assumed 
in the processes of chylification and chymification. 

"There can be no doubt," says Simon, "that there are 
anomalies in the process of chylification, in consequence of 
which an unsuitable chyle is prepared and conveyed to the 
blood, modified both in its quality and quantity ; but with 
respect to the particulars of these anomalies we are still per- 
fectly in the dark." 

These anomalous processes mark the character and prog- 
ress of indigestion, and take on the name of dyspepsia, in 
which there may be a derangement of the stomach mani- 
fested in a variety of ways, the imperfectly chylified food en- 
tering the circulating blood, not only fails to replenish the 
different organs of the body, but becomes in itself a source 
of irritation. As a general thing, however, there is a torpid 
or inactive state of the liver, or some derangement o( the 
chylopoetic viscera in connection with it 



198 Urino-Pathology. 



When the stomach becomes affected primarily, and -without 
some derangement of the hepatic system in connection, it is 
seldom of long duration, but will readily yield to appropriate 
remedies, and soon recover its wonted tone and energy. In 
these cases we find a peculiar state of the urine, indicating 
not only the defective assimilation of food, but an affection 
of the stomach itself. 

Without examining the particular changes in the blood in 
this disease, it will be enough for our purpose to describe 
those in the urine ; and Dr. Bennet is " surprised that so lit- 
tle attention has been paid to the urinary secretion in dys- 
pepsia, even by those pathologists who have written profess- 
edly on the subject ; as the changes that take place in that 
secretion afford most valuable indications, not only for diag- 
nosis but also for treatment and the regulation of the diet." 

"As we have seen," continues Bennet, "if the lithates 
are too abundant to be held in solution by the warm urine, 
it is turbid from the first ; if they are all dissolved by the 
urine while warm, but too abundant to be held in solution 
when cold, the urine becomes turbid as it cools. When the 
digestive and nutritive processes are very much impaired, 
these changes in the urine may be observed, whenever it is ex- 
amined. If they are less deeply disordered, it is only two, 
three, or four hours after the ingestion of food ( according to 
the length of time it takes to digest), that the urine contains 
the anomalous salts, and is turbid, or becomes so on cooling. 
If the digestion is still less affected, the lithates only appear 
in the urine, after the ingestion of animal substances, or an 
article of food of difficult digestion, etc. 

From the above quotations or facts, it seems evident that in 
these instances the presence of the anomalous salts in the 
urine is entirely the result of depraved digestion. 

The kidneys, in dyspepsia, owing to the imperfectly assimi- 
lated substances, as well as the depraved condition of the bile, 
throw out the effete matter in the shape of ammonia, triple 
phosphates, oxalate of lime, etc., but especially is this latter 



Vrino-Pathology. 199 



substance a constant ingredient in the urine in every case of 
indigestion, from whatever cause. The principle morbid pro- 
duct then in dyspepsia, to be found in the urine, will be oxalate 
of lime, the urate of ammonia, etc., being often only a con- 
comitant, because of some other complication. 

Golding Bird has given a number of illustrative cases of 
oxalate-of-lime deposits in the urine, and says that from the 
symptoms presented in cases of this disease, there is no#diffi- 
culty in proving, to a demonstration, the positive and constant 
existence of serious functional derangement of the digestive 
organs, especially of the stomach, duodenum, liver, etc., when 
these deposits are found in the urine. 

To examine urine, for the purpose of detecting the existence 
of the salts under consideration, allow a portion passed a few 
hours after a meal, to repose in a glass vessel ; on cooling it 
will become turbid, and finally a dense deposit of urate of 
ammonia will take place. This, especially if accompanied with 
purpurine, will give evidence of derangement of the liver in 
connection. If there be dyspepsia only, there will be in the 
lower layers of the urine an opake deposition of a cloud of 
vesical-like mucus. Decant the upper portion, and pour the 
remainder into a watch-glass and gently warm it over a lamp, 
when a deposition of the crystals of oxalate of lime will be 
present ; this may readily be examined with the microscope. 
( See Chart, Fig. 8 ). 

"By allowing the urine to repose, and placing a drop of 
the lowest strata on a plate of glass, placing over it a frag- 
ment of thin glass or mica, and then submitting it to the 
microscope, the crystals diffused through the fluid will become 
beautifully distinct," says Bird. 

Chemically, oxalate of lime is known by being insoluble in 
aqua-potassa\ insoluble in acetic acid, soluble in nitric acid, 

and convertible, at a red heat, into carbonate o[ lime. 

There seems to have already been enough said upon this 
subject to enable anyone to determine a ease of dyspepsia. 



200 Urino-Pathology. 

with or without the the usual complications ; but in conclusion, 
we will make the following quotations from "Bennet on 
the Uterus:" 

" From what precedes, it must be obvious that the examina- 
tion of the urine is calculated to be of great assistance in 
estimating the extent to which the uterine disease has reacted 
on digestion and nutrition ; it is also a valuable mode of ascer- 
taining, week by week, how far those functions have rallied 
under the means of treatment used. Owing to the intimate 
connection which exists between imperfect chylification and 
the presence of lithates, etc., in the urine, and the facility 
with which their presence may be ascertained, if the attention 
of the patient is directed to the urinary secretion, and the 
nature of the changes that take place is briefly explained to 
her, she is put in possession of a most simple and efficient 
means of regulating her diet, both as to quantity and quality. 

" She soon learns that by noticing the urine, two, three, 
or four hours after the ingestion of food, she can tell whether 
the meal has been properly digested or otherwise, and thus 
becomes able to diminish or change her diet, as may be re- 
quired. The information thus obtained is the more valuable, 
as a dyspeptic may not be apprised of the food she has taken 
not having been properly digested, by any other appreciable 
symptom. 

" These remarks apply with equal force and truth to some 
of the most ordinary forms of dyspepsia, when existing with- 
out any uterine complication." 

In all cases of oxalate of lime in the urine, the patients 
complain of well-marked dyspeptic feelings, with many times 
great nervous depression, emaciation and hypochondriacal im- 
pressions. 

The treatment of dyspepsia should be varied according to 
the extent of the disease, and the nature of the complications, 
if any. We have prescribed the following with very good 
success in ordinary cases, to-wit : 

One grain of eupatorin and poplin, half an hour before each 



Urino-Patholoyy. 201 



meal ; .Beach's Ncutraling Cordial, seven ounces ; tinctures 
capsicum, ginger and myrrh, three drachms. 

Dose, from half to a table-spoonful half an hour before 
each meal, with one grain podophyllin and three grains 
Dover's powder, to be taken at bed-time. 



NERVOUS DISEASES 



There is a large number of diseases classed under the above 
head, all of which partake more or less of the same general 
characteristics. 

As it is our principal object to notice only the peculiarity 
of the urine in different diseases, to better enable practitioners 
to arrive at more correct conclusions respecting the nature of 
the maladies, Ave find ourselves particularly favored with con- 
tributions from the research of others, in this class of dis- 
eases. And it is in this class particularly, that some more 
definite mode is especially required, because of the general 
incapacity of patients laboring under hypochondria, hysteria, 
delirium, and other mental disorders, to give any very reliable 
or correct description of their symptoms or feelings. 

It has long been known that certain emotions of the mind 
very materially affect the discharges from the kidneys ; or, at 
least, that these certain changes in the character and quality 
of the urine take place under these certain emotions of the 
mind. And if it be true, that every thought emanating from 
the brain, involves the decay of a certain amount of cerebral 
substance, and that such influence of mental exertion on the 
metamorphosis of tissue, is exhibited in the composition of the 
urine, as has been abundantly proved by the interesting ex- 
periments of Dr. Hammond of the United States Army, it 
surely becomes a question of great importance to ascertain the 
character of such secretion in all nervous and mental diseases 
or excitements. 

Dr. Hammond conducted a series of experiments upon his 
own person for the purpose of ascertaining the effect upon 
the urine, of increased or diminished mental exertion. Per- 
forming the experiments upon himself, made it easy for him 
to obtain standard amounts of the several constituents of the 



Urino-Pathology. 203 



urine with which to compare the results ; and to exhibit the 
manner of conducting these experiments we make the follow- 
ing extracts from his own pen. He says : 

"I therefore reduced my food, mental labor, and physical 
exercise, to a system ; appropriating eight hours to sleep, three 
to bodily exercise, seven to study and six to recreation, eating, 
and the performance of daily duties requiring but little mental 
or physical exertion. 

"During the twenty-four hours, I consumed sixteen ounces 
of beef (broiled and roasted), twelve ounces of bread, one ounce 
of butter, eight ounces of potatoes, and two drachms of com- 
mon salt. In the same period I drank thirty-two ounces of 
water; no other food, solid or fluid, was taken into the system. 

" Under the several conditions of food, exercise, etc., above 
specified, I examined on ten consecutive days, the total amount 
of urine excreted, during each period of twenty-four hours, 
taking a note of the amount of urine, uric acid, chlorine, 
phosphoric and sulphuric acids respectively.'' 

The result of these analyses he gives in tabular form. The 
average products per day of this first course of experiments, 
sums up, the urine, in ounces and decimals of an ounce, the 
other products in grains and decimals of a grain ; thus : urine, 
36.55 ounces; urea, 670.62 grains; uric acid, 14.44 grains: 
chlorine, 154.80 grains; phosphoric acid, 43.66 grains: sul- 
phuric acid, 38.47 grains. 

He then, with a view of determining the influence of in- 
creased intellectual exertion, says : 

" I doubled the number of hours appropriated to study. 
taking for this purpose, three hours from the number given to 
sleep, and four from that assigned to recreation, etc., making 
a total of fourteen hours of the twenty-four, during which the 
mind was intensely occupied. This system L continued for 
ten consecutive days.. The urine was examined in the same 
manner as before." 

The result of these analyses, the second course o[' experi- 
ments, gives the following : urine, 43.50 ounces; area, 7 18.33 



204 Urino-Pathology. 



grains; uric acid, 10.65 grains; chlorine, 172.72 grains; phos- 
phoric acid, 61.15 grains; sulphuric acid, 49.15 grains. 

The influence of diminished mental labor was next to be 
ascertained, and with a view to that end he proceeded and 
says : 

" I, therefore, omitted studying entirely, and passed seven 
hours allotted to it in the standard experiments, in reading 
light literature, and otherwise beguiling the time in amuse- 
ments requiring but little mental exertion. As previously, 
this was continued for ten consecutive days ; the food, exer- 
cise, etc., remained unaltered." 

The effects of this the third course of experiments upon 
the urine is given as follows: urine, 32.14 ounces; urea, 
586.65 grains; uric acid, 17.12 grains; chlorine, 141.94 
grains; phosphoric acid, 25.40 grains; sulphuric acid, 35.81 
grains. 

These results, he thinks, can not be doubted, and are too 
well marked to admit of any other conclusion than the fol- 
lowing, which he briefly states thus : " 1st. That increased 
mental exertion augments the quantity of urine. 2d. That by 
its influence, the urea, chlorine, phosphoric and sulphuric acids, 
are increased in quantity. 3d. That the uric acid, on the 
contrary, is very materially reduced in amount. 4th. That 
diminished intellectual exertion, produces effects directly con- 
trary to all the above. 

"Thus," he says, "the brain is seen to follow the same 
general law which governs the other structures of the body — 
increased use promotes increased decay, and the products of 
this decay, are, in like manner, removed from the system to 
make way for newer matter." 

Intense mental labor, by accelerating the metamorphosis of 
the cerebral tissue, necessarily requires the removal of that 
tissue, and the above facts respecting the removal of these 
metamorphosed tissues by the urinary secretion, and their easy 
detection in that fluid, at once put us in possession of the data 
whereby we may judge of the nature and extent of the disease, 



205 Urino-Pathology. 



as well as prescribe the appropriate remedy. It is from ex- 
periments like those of Dr. Hammond, and from the anatom- 
ical structure, chemical composition, pathological conditions, 
lesions, etc., and the changes produced in the blood by poisons 
and by disease, and the effects of these changes, conditions, 
lesions, etc., upon the urinary secretion, that this theory, of 
diagnosis by the urine is founded, and especially is it well sup- 
ported in this class of diseases. 

From the earliest time, the brain has been considered the 
established seat of the mind. The color and consistence of 
the whole "nervous system" is different from that of any 
other part of the body, its chemical composition varying from 
all other parts. And, according to Baron Haller, "a fifth- 
part of the whole blood in the body of man is sent to the 
brain." And, when we find the effect of certain poisons, as 
alcohol for instance, to be so universally the same upon the 
nervous system, and can trace it from the stomach into the 
blood, from the blood to the brain, and from the brain making 
its exit by the urine, as was done by Dr. Percy, have wc 
not good reason to regard that secretion as an excellent medium 
for imparting a knowledge of the nature of the disease ? 
Magendie adopted the view that all poisons arc absorbed into 
the blood, however quick their action, and destroy life by 
contact with the vital organs. 

"Arsenic has been discovered by Orfila, in the viscera and 
urine of those who have been poisoned by it, both during 
life and after death, and it would appear that the living, in 
the case of arsenical poisoning, are constantly eliminating the 
poison by the urine." 

"The fact," says Taylor, "that arsenic may be detected 
in the blood and urine of a person who survives its etu\ 
is a point of considerable importance in a medico-legal point 
of view." "An analysis of either of these fluids the 

same author, "may furnish evidence otherwise only satisfac- 
torily obtained by a, post-mortem examination of the body : 
and eases of criminal administration of arsenic to the living, 



206 Urino-Pathology. 



which have hitherto escaped the hands of justice, owing to 
the want of chemical proof, may become as clearly estab- 
lished to the satisfaction of a jury, as if the poison had 
operated fatally, and had been found after death in the 
stomach." 

The fact, then, that intense mental labor universally increases 
one set of constituents in the urine and decreases another 
set, and vice versa, in diminished mental labor ; and that 
the constituents so found in excess in the urine, under high 
mental excitement, are the ingredients that are deficient in 
the urine of those who are deficient in mental capacity (as 
in the brain of idiots, for instance, in which there is an en- 
tire absence of the phosphoric element, and in their urine a 
deficiency of the same), as also the effect of alcoholic stim- 
ulants upon the blood, brain, and urine, and the hand-and- 
hand correspondence of the blood and urine, in cases of other 
poisons ; these facts, we may say, furnish us a sufficient 
foundation for the investigation of nervous disorders by the 
examination of the urine, under the different stages of men- 
tal and nervous excitement that may arise. 



APOPLEXY. 



The functions of the brain and nervous system, like the 
functions of organs generally, depend on the supply of 
blood to the part, and the good or bad quality of that fluid, 
for their due or undue performance. A due proportion of 
the properties of the nervous substance of the brain itself 
must accompany the blood to that organ, to supply the wear 
and tear to which it is subject; also, the prompt removal of 
the old material must take place, to insure a healthy action of 
the functions of that organ. 

" If blood does not circulate freely through a limb, the 
sensations are impaired and its power to act reduced ; and if 
too freely, the sensibility is exalted. Over-exertion of the 
faculties, or excitement of the mind, is chiefly felt in the func- 
tions of its own organs, the brain and nervous system. Hence 
may arise," says Williams, "congestions of the brain, exhaus- 
tion of nervous power, apoplexy, epilepsy, palsy, etc. 

This class of diseases may be divided into excess and defect 
of blood to the part. The one constituting those of the nature 
of congestion ; the other, those rather of recession, or the deficit 
of stimulus to the nervous matter. The former constitutes the 
inflammatory, the other, the non-inflammatory type of nervous 
disorders ; and in the one we find the urinary secretion giving 
evidence of the same character, the " reddish-tinged ilocculi " 
being observable, with a reddish-gray sediment, the phosphoric 
acid and other phosphates, while in the other, these phosphoric 
deposits are observable in the clear, pale urine o\' defective 
blood. 

The urine in apoplexy is always alkaline to test-paper, the 
specific gravity above the average, and contains a trace of the 
reddish-tinged Ilocculi, deposits of phosphoric acid and ether 



208 Urino-Patlwlogy. 



phosphates; and if the disease is of a violent character, an 
excess of urea will be deposited. 

This class of nervous diseases might be regarded as inflam- 
mato-nervous ; and under this head might be named apoplexy, 
epilepsy, and catalepsy, when they are produced by an excess 
of blood to the brain; and here the urinary secretion is of 
particular moment in diagnosing or determining whether the 
results which characterize these diseases, have been brought 
about by excess of blood to the brain, or from other causes, 
as they are known many times to be. 

The peculiar mark of inflammatory urine in the one case, 
contrasted with the absence of said mark from that secretion, 
when from otlier causes, will very readily enable one to 
decide. 

The phosphates being in excess in this kind of urine, they 
will be dissolved by diluted hydrochloric acid, and found in- 
soluble in liquor-ammonia or potassa. 

Dr. Bird says : " One general law appears to govern the 
pathological development of these deposits, viz : that they 
always exist simultaneously with a depressed state of nervous 
energy," etc. 

Treatment: As this disease so much resembles an attack 
of inflammation of the brain, and as a similar train of symp- 
toms and pathological indications are apt to follow, the treat- 
ment required in the former would not be bad for the lat- 
ter, after the first or most urgent symptoms are relieved by 
local applications, etc. 



EPILEPSY. 



When the above disease is marked, as it often is, by an 
undue determination of blood to the brain, the urinary secre- 
tion will give similar marks to that of the urine in apoplexy. 
And, in fact, so far as the treatment is concerned in such a 
case, during the epileptic fit, there should be but very little 
difference, as in both it should be directed at once to the remo- 
val of the tension upon the brain. 

If, however, the difficulty should arise from other causes, or 
should there be no excess or determination of blood to the 
brain, ocular inspection of the urine will alone sometimes 
develop the fact, by exhibiting the general marks of disorder 
without the evidence of inflammatory action. 

The urine will be of lighter color, of light specific gravity, 
and will contain more phosphoric acid than is contained in that 
of the^sanguineous variety. In an uncomplicated case of epi- 
lepsy, the other functions of the body being all duly performed, 
the urine will be of the standard quality in every respect save 
the excess of phosphates. 

Very ordinary mental emotions, however, will very mate- 
rially and suddenly affect a change in the urinary secretion, 
anger, terror, surprise, joy, etc., all having a very decided 
effect thereon ; therefore, to guard against these, the urine 
passed after a night's rest only, should be depended upon. 

We have examined a great number of specimens of urine 
from epileptic patients, and in all those uncomplicated with 
other disorders, if the specimen used was taken shortly after 
the "falling fit," it was clear, pale and limpid, exhibiting 
evidences of nervous weakness ; but that taken the following 
morning was generally hazy, indicating an excess o( phos- 
phates, and deposited the same on repose, 



210 Urino-Pathology. 



As time passes on from the attack, the urine becomes more 
normal in appearance, and in some cases soon assumes almost 
the natural amber-tint also, in proportion as the patient ac- 
quires his usual nervous energy. 

The treatment should be such as would have a tendency 
to allay nervous excitement, and to stimulate the heart to a 
regular propulsion of appropriate blood to the brain. 

If there is an undue proportion of blood thrown upon the 
brain, and an unequal circulation of that fluid, there is no 
remedy in our experience, equal to the English digitalis, given 
in decoction. It is, without doubt, the only remedy that will 
not disappoint the expectations ; phosphate of iron, valerian, 
and scutellarin, may be used in connection with advantage, 
however. 

If the excitement is occasioned by worms, uterine de- 
rangement, or any other cause, the treatment must be varied 
accordingly. We have cured a number of cases of epilepsy in 
the young male subject by appropriate treatment for the 
removal of worms in connection. Also, a number of cases 
of females, wherein uterine difficulties were presented, and 
which perhaps contributed much to the production of the fits. 
In this latter case we place great reliance in the virtue of 
the tincture of macrotys racemosa, in connection with our 
usual remedies. 



DELIRIUM TREMENS. 



"The nervous system," says Williams, " is an especial 
subject of the disordering influence of intoxicating liquors." 
If taken in large quantities it induces cerebral excitement, 
and if continued too long, congestion of the brain, and in ex- 
treme cases the spinal marrow suffers ; hence, apoplexy, palsy, 
phrenitis, etc., may result, in which case the same symptoms 
as are manifest in those diseases, would follow, and the same 
changed condition of the urine be presented, with the addition 
only of the alcoholic substance which may be detected therein. 

The most disastrous consequences are exhibited by the 
habitual drunkard, who, in proportion as he indulges in liquor, 
becomes subject to delirium tremens, the "drunkard's disease." 
The alcoholic poison soon induces other affections, depraving 
the appetite and destroying the powers of digestion, which but 
adds to the nervous exhaustion — the patient drinking and 
starving, and finally dying from exhaustion of inanition. 

The brain and nervous system having been kept in a contin- 
ued state of excitement by the alcoholic stimulants, the blood 
all the while receiving no nourishment for replenishing the 
wear and tear of the system, until at last forbearance ceases 
to be a virtue, the nerves arc made to succumb to ex- 
haustion, and the mind to hallucination. 

With this state of blood, its vital properties reduced to the 
last stage of poverty and want, even to the last drop of nour- 
ishment contained in it, what could wo expect to find in the 
urine secreted therefrom ? Clear as crystal-water almost will 
bo the How, the damning poison only, scents the system 
through. 

Dr. Percy detected alcohol in the urine of a mania-a-potu 
subject, and Drs. Christ ison and Fcrcy separated alcohol from 



212 rrino-Pathology. 



the brain by distillation, as also from the blood of a habitual 
drunkard. 

Delirium tremens is undoubtedly a disease of debility and 
exhaustion of the blood, which debility falls most heavily on 
the brain and nervous matters ; and to which is added the 
active poisonous effect of the alcohol. 

There will be no trouble in detecting this disease by an ex- 
amination of the urine, after having once inspected and tested 
a specimen. In the early stage of the disease, and before the 
delirium has fully set in, the specific gravity of the urine may 
not be so light, nor yet its color so light, as it may still contain 
more or less of the tinge of inflammation, as also some of the 
unassimilated food of indigestion, as after the delirium has 
been developed. But in the wildness of delirium, the urine 
will be as clear as water, and contain a few small flakes of 
phosphoric acid, to be seen only by the microscope; and it will 
also have the oder of alcohol- 

To detect the alcohol in the urine -without the trouble of dis- 
tillation, drop in the vessel containing it, a few grains of bi- 
chromate of potash, then add a few drops of the oil of vitriol. 
If alcohol be present, "even only in the proportion of a drop to 
half an ounce or ounce of water," says Dr. Thompson, "green 
oxyde of chrome will be set free, and the odor of aldehyde will 
be perceived. 

This is a valuable test, and is worthy of confidence ; distilla- 
tion, however, very readily detects the alcohol. 

As long as nervous exhaustion can be averted, by repeat- 
ing the stimulus, and keeping up the strength and vivifying 
properties of the blood, the disease in its virulent form may 
be warded off; but when, in consequence of the complete ex- 
haustion of these properties and the nervous matter, stimu- 
lants fail to arouse the system to its wonted action, or the 
organs to their regular functions, delirium, hallucination and 
insensibility take place. 

Treatment : Rest, quietness of mind and body, and the ad- 
ministration of another form of stimulant in connection with 



TJrino-Pathology. 213 



tonics and diuretics. Give ammoniated valerian, as a counter- 
acting stimulant to the alcohol, with the tonics, hydrastin, lupu- 
lin, and iron, to bring up the state of the blood ; and diuretics, 
as uva ursi, buchu, or digitalis, to carry off the alcohol. 

Dr. J. C. B. "Williams takes a rational view of the treatment 
of this disease and says : " The excretory functions are imper- 
fectly performed, the urine is no longer freely secreted, and 
as long as the secretions are defective the nervous excitement 
continues ; the leading object, therefore, should be to purify 
the system by means of an increase of the secretions, and espe- 
cially by diuretic remedies." This would certainly be a justly 
scientific course of treatment of delirium tremens and deserves 
to be more frequently tried. 

It is said that the amanita muscaria, a species of fungus, 
produces inebriation, and that the inhabitants of Northern 
Asia use it for this purpose. He who has eaten it will, in the 
course of twenty-four hours, have slept himself sober ; when, if 
he takes a teacupful of his urine, he will again become intox- 
icated ; and a party of drunkards, it is said, may keep up their 
debauch for an indefinite period of time by drinking the urine 
of each other — one only having eaten the fungus. 



HYPOCHONDRIA. 



The above disease, together with some forms of insanity, 
generally arise from too great exertion of the mental faculties, 
or too long continued application of the mind upon the same 
subject or class of subjects, and consequent waste of nervous 
matter, together with want of blood-globules in the blood. 

The chemical analyses of the brain of idiots, exhibits an 
almost entire absence of the phosphoric element, or phosphorus, 
according to the experiments of a number of authors ; and in 
accordance with the deficiency of this constituent may the de- 
ficiency of mental power be estimated. 

"Almost every act of the mind," says Dr. Carpenter, "is 
inseparably connected with material changes in the nervous 
system, and hence the more prolonged and energetic the ope- 
rations of the mind, the greater is the waste of nervous matter, 
which is evinced by an increased amount of phosphates in the 
urine." 

Here then we have the data for the measurement of the de- 
grees of deviation from a healthy standard of the nervous sys- 
tem, which will enable us to calculate, with almost mathematical 
precision, the state of the mind even, by an examination of the 
urine. 

The author above quoted farther says, that the peculiar in- 
gredient of the nervous tissue, is a fatty acid, containg a 
very small proportion of azote, but united with a considerable 
amount of phosphorus. The amount of change which takes 
place in this or any other tissue, may be estimated in t"wo 
ways : first, by the apperance, in the excretions, of its peculiar 
ingredients, set free by decomposition ; and, second, by the 
demand set up for the material for its reformation. 

Now it is well known, that, when the nervous system has 
been in unusual activity, there is a marked increase in the 



Urino-Pathology. 215 



phosphoric deposits in the urine ; and as the quantity of phos- 
phorus in any other of the soft tissues, is very considerable, 
it is scarcely possible to attribute this liberation of phosphorus 
from the system to any other cause than the waste of nervous 
matter — that is, its decomposition, resulting from the discharge 
of its vital function. 

It is evident to all investigators of this subject, that the 
urine in mental disorders, and especially those of a non- 
inflammatory and more chronic form, not only gives out more 
than its accustomed share of the nervous matter or phosphoric 
substance, but that the excess so given out, is coexistent 
with, and in the ratio of, the existing disease. We have then, 
only to discover the extent of deviation in this particular, from 
the healthy standard of urine, to enable us to determine, not 
only the character of the disease but its extent also. 

Whenever, therefore, we find the urine to contain more than 
two andtwo-ten ths parts of phosphoric acid, in one thousand 
parts of urine, that being the average in health, all other parts 
of the urine being normal in quality and proportion, we can 
readily calculate the nature and extent of the disease. This 
kind of urine is generally paler than the natural, and if the 
disease is considerably extensive, is somewhat hazy in appear- 
ance. It is always alkaline to test-paper, and the phosphates 
may be easily detected by the addition of dilute hydrochloric 
acid, which dissolves it, or the addition of liquor-ammonia or 
pottassa which does not. 

If there be complications, such as dyspepsia, for instance, 
these will be marked by their usual indications also, in the 
urine. The well-marked dyspepsia will always be shown bj 
the oxalatc-of-lime deposits in the urine, the tests for which 
ingredient, sec Dyspepsia ; also Chart, Fig. 8, for microscopic 
view. These will enable anyone to detect any variety of 
hypochondriacal or dyspeptic urine. 

The treatment of hypochondria, should be such as would 
relieve the wear, tear, and excitement c>f the brain and ncr- 



216 Urino-Pathology. 



vous system, to prevent the disintegration of the nervous mat- 
ter, and to supply the deficit that has been carried off. 

Remove exciting and depressing influences, and substitute 
rest, quietude, but not solitude, vrith pleasing associations, and 
occasionally, even cheerful and joyous exultations. 

Give bitter tonics, dydrastis, iron and wine, with the phos- 
phates of lime, iron and soda ; together vrith a bland, nutri- 
tious diet — beef-tea, soups and calves-feet jelly. 



PARALYSIS. 



Tins disease, although perhaps more nearly allied to apo- 
plexy or diseases of the inflammato-nervous character, yet as 
it may sometimes be produced by enervation of the system, 
or as the loss or diminution of power of voluntary motion, are 
not always to be attributed to inflammatory action, it may 
be well to mention here that the urinary secretion is of the 
most vital importance in determining the facts and discrim- 
inating between them. 

" Paralysis may arise," says Cooper, " in consequence of 
an attack of apoplexy. It may likewise be occasioned by 
anything that prevents the flow of the nervous power from 
the brain into the organs of motion. The long-continued 
application of sedatives, also, will produce palsy, as we find 
to be true of those whose occupations subject them to the con- 
stant handling of white lead, etc." 

If, from an attack of apoplexy, or from any inflammatory 
condition of the blood, the urine will exhibit the usual marks 
in inflammation so well known. If from a lack of flow of 
nervous matter, that deficit will change the quality of the 
urine, in the reduction of one of its proportionate constitu- 
ents. If from the introduction of a foreign substance into 
the circulation of the blood, as lead, for instance, that sub- 
stance will be found in the eliminated urine. 

Orfila detected lead in the urine of a female who had sm al- 
lowed the acetate ; " and during life it appears to be elimina- 
ted chiefly by the urine," says Taylor, on Poisons. 



CHOREA— (St. Vitus' Dance). 



This disease is generally of a non-inflammatory character, 
and belongs to the class of nervous disorders, of rather a 
convulsive kind. Some have thought it nearly allied to par- 
alysis. 

Various causes may contribute, however, to the production 
of this disagreeable disease, among which may be enumerated 
teething, worms, poisons, violent affections of the mind, as 
anger, fear, horror ; as also, whatever produces general weak- 
ness of the system, and poorness of blood — aglohulia, or want 
of blood-globules. 

From whatever cause the disease is propagated or the con- 
vulsive motions of the limbs may be produced, the charac- 
teristic marks of the urine will determine. If from teeth- 
ing, " the chief danger of dentition," says Simon, " is refer- 
rible to the vascular excitement of the brain." As long as 
the kidneys act freely there is little or no risk in the symp- 
toms of mere dentition. When the urine is scanty and high- 
colored, the circulation seems to be both oppressed and ex- 
cited. If from worms, the usual milky appearance of the 
urine will be perceptible. If from poisons, the substance or 
poisonous matter may generally be detected in the urine. And 
if from violent fits of passion, the urinary secretion will ex- 
hibit the purely nervous character, so well known. 

The treatment must be varied in accordance with the cause 
of the affection, and in this lies the real value of the Uros- 
copian system — the detection of the true cause. 



HYSTERIA 



This, the last of the nervous diseases, which we shall no- 
tice, though by no means the least, in point of vexation to 
practitioners, or frequency of attack, may be taken as the 
grand type of all non -inflammatory nervous disorders. 

"Aglobulia, or want of blood-globules, has for its distin- 
guishing mark," says Merchand, "a disturbance of the- ner- 
vous system. Women have a smaller proportion of blood- 
globules than men, therefore they are more subject to ner- 
vous maladies ; this smaller proportion of the blood-globules 
in them may be ascribed to their periodical hemorrhage." 

Sydenham affirmed that two-thirds of the female world suf- 
fer from hysteric symptoms ; and also conceived that there 
is no difference between hysteria and hypochondriasis. 

It has been observed that nervous diseases have a ten- 
tency to subside after the critical age of women, and it is an 
equally observed fact that, after this period of life, the blood- 
globules acquire an increased proportion, owing to the ces- 
sation of menstruation. 

It has been said, with some show of truth, that " chlorosis 
is the aglobulia of young girls and often of young men : hys- 
teria, the aglobulia of females from twenty -five to fifty-five 
years of age, and hypochondriasis the aglobulia of grown 
men." 

The medium or standard proportion of blood-globules being 
one hundred and twenty-seven parts in one thousand of Mood, 
they arc many times reduced in this disease to as low as 
forty-three parts, ami in chlorosis sometimes as low as twenty- 
four parts in one thousand oi' blood, according to Amlral. 



220 Urino-Pathology. 



It is a well-known fact, that "nervous persons" are gener- 
ally spare and thin of flesh, or that those of a "nervous tem- 
perament are seldom or never fat." 

The nervous matter is chiefly formed, according to Carpen- 
ter, " out of the same elements as those which would otherwise 
be employed for adipose tissue, but which the continual use of 
the nervous system prevents from being deposited, and which 
is carried out by the urine, as is observed in its phosphoric 
deposits." 

That the urine in these disorders, and especially in hysteria, 
is of a peculiar character and quality, every physician of ex- 
perience knows; even nurses themselves are well acquainted 
with the fact, that there is generally a large flow of clear, lim- 
pid urine after an attack of hysteria. 

That there is an excess of water there is no doubt, the stand- 
ard proportion in healthy urine being nine hundred and fifty- 
six parts in one thousand ; in some cases the excess has been 
known to reach thirty-nine parts abov, emaking nine hundred 
and ninety-five parts, leaving only five parts in one thousand of 
urine to be made up of the other constituents, the principal of 
which were generally the phosphates. 

The urine coming from blood which is almost destitute of 
globules, could not well be much else than water, where no 
other affection or contamination of blood is present. It will be 
clear, pale and transparent, scarcely a trace of anything to 
give it color or consistence. 

"The experienced physician," says Aldridge, "can at once 
perceive, if the urine be pale and transparent, although 
strabismus, convulsions, delirium, heat of head, and bounding 
carotids should all display themselves, he can confidently say : 
'There is no inflammation here; this is hysteria.' ' 

This condition of the urine, contrasted with the higher 
colored and more concentrated urine of the partially inflamma- 
tory, or the inflammato-nervous diseases, as apoplexy, etc., will 
be our chief guide in making up a diagnosis. Remember that 
there is, in the inflammato-nervous, the tinge of reddish floe- 



Urino-Pathology. 221 



culi, and the more natural pcoportion of water in the one, and 
the paleness and large excess of water in tho other. The 
phosphoric deposits may be detected by the usual chemical and 
microscopical rules, where the unpracticed eye is unable to de- 
termine, or where the quantity is insignificantly small. Hys- 
teria, however, may sometimes be the result of other disease, or 
at least, somewhat complicated with it, such as dyspepsia, ute- 
rine diseases, etc. ; and in such cases the usual characteristic 
changes of the urine in these diseases will be apparent also. 

The treatment indicated in all these kinds of disorders, in 
order to a perfect restoration, or to perform a complete cure, 
must be directed to the restoration of the blood to its normal 
standard, to increase the number of blood-globules and thereby 
r educe the watery excess in the urine. This is best accom- 
plished by vegetable tonics and astringents, with generous diet, 
wine, iron, and stimulating bitters, with antispasmodics to calm 
the nervous system. 



CHRONIC RHEUMATISM. 



Although this disease sometimes follows that of the more 
acute form, or inflammatory type, still a very great differ- 
ence is to be observed in the constituents of the blood as 
well as the urine. 

It is now pretty generally conceded, 'and the experiments 
of Drs. Day, Garrod and others, show that it depends on 
the production in the system of an excess of lithic acid. 

Rheumatism is especially liable to occur as an effect of 
cold, or check of perspiration, and as the perspiratory se- 
cretion contains lactic acid, the skin failing to excrete that 
substance, if the kidneys should at the same time fail to 
remove it, there must be an accumulation of it in the blood, 
which, "acting as a ferment, with its kindred products, lithic 
acid and its compounds, contaminates that fluid. 

Dr. Garrod readily detected lithic acid in the blood of 
rheumatic and gouty patients. 

That there is an excess of uric acid, or lithic acid, in the 
blood of rheumatic patients there is not a shadow of doubt, 
and in this respect the acute form agrees also with the 
chronic; and that it acts upon the muscular and nervous 
systems, producing pain, contractions, etc., belonging to 
rheumatism, is also true. It appears to exist there after 
the form of some kinds of poison, or as an abnormal ingre- 
dient, which has accumulated in the system, and for a time 
is deposited there. 

In the chronic form of this disease during the accumula- 
tion, and in fact almost during the existence of this sub- 
stance in the blood and tissues of the body, to which it should 
be a stranger, there is little or no appearance of it in the 
excretions, to which that product more properly belongs. 



Urino-Pathology. 223 



This deranged or vitiated state of the blood is the first 
link in the chain that makes up a case of rheumatism, and 
the deranged condition of the organic system of nerves and 
muscles are merely secondary consequences. It is in vain, 
then, to attempt its cure by external applications. 

The pathology of chronic' rheumatism being the result of 
an accumulation of this acid in the blood, is farther proved 
by its non-elimination during the existence of the disease, 
and its characteristic appearance in the urine, upon the sub- 
sidence of the disease under appropriate treatment. 

There is in this disease almost a total absence of lithic 
acid in the urine, until a crisis takes place, or by appro- 
priate treatment that substance is eliminated by it, when 
almost immediate improvement of health is observed. 

Dr. Prout says: " Whoever has attended much to urinary 
diseases must have remarked, that many individuals, subject 
to these derangements of health, seldom feel so well as when 
lithic acid deposits take place in the urine." 

The same author says that lithic acid maybe considered the 
maleris morbi that is the cause of irritation in the constitution, 
when, if the kidneys can be made to secrete it in large quanti- 
ties, the system will immediately be relieved, and thus an arti- 
ficial crisis may be brought about by diuretic remedies. 

The urine in the first stage Avill be entirely devoid of uric- 
acid, but after the disease is fully set in, will begin to exhibit 
traces of that ingredient. It is always of lighter specific 
gravity than normal urine, until the crisis, whether from the 
efforts of nature alone, or the use of medicines, when it 
becomes heavier, and assumes a darker and muddy-like ap- 
pearance. And, in this, as in many other diseases, " the 
heavier the sediment lies at the bottom, and the clearer the 
urine is that stands over it, the more decided is the Qlisifi 
allowed to be; while the lighter the sediment floats, and the 
less disposition there is to a quick and perfect deposition, the 
more imperfect the crisis." 



224 Urino-Pathology. 



Of all the remedies for chronic rheumatism, colchicum seems 
to have been given the preference, as being the most certain to 
produce abundance of uric acid deposits in the urine, especially 
if given in combination with iodide of potassium and saline- 
waters. These increase the action of the kidneys, and drain 
the offending matters from the system. 

Dr. Lewis says : " Colchicum causes an augmented dis- 
charge of this and other principles of the urine." " In slight 
cases of rheumatism," says Williams, " sudorifics may suffice, 
but colchicum and alkalies, opium, and iodide of potassium, 
more speedily and permanently remove the disease." 

In old or long-continued cases of chronic rheumatism, con- 
cretions or thickenings take place in the fibrous, cartilaginous 
and white-tissues generally. These are owing to the deposit 
in them of soda and lime in combination with the lithic acid. 
It is in this combination that it is presumed to exist in the 
blood. 

" Taking into account these two prominent facts, the excess 
of lithic acid found in the urine at the period of convalescence 
from rheumatism, and the subsequent deposit of soda and lime 
in the white-tissues," Dr. Buckler proposes to decompose the 
soda and lime in the blood, by the administration of phosphate 
of ammonia, and says that thickening of the white-tissues, of 
long standing, has disappeared under its use. Even in those 
cases where convalescence had already commenced, and the 
lithic acid was present in excess in the urine, it at once 
disappeared under the use of phosphate of ammonia. 

It is thought by some, that to saturate the fluids of the body 
for a sufficient length of time, with the phosphate of ammonia, 
the calcareous substance must be dissolved. 



GOUT. 



This disease seems to be a species of rheumatism, being 
very similar in many respects. Dr. Black says, " the princi- 
pal difference consists in this, that in rheumatism the local 
disease affects the larger joints, while the gout affects the 
smaller ones, the toes, etc." 

Dr. Garrod has in several cases of gout detected lithate of 
soda in very appreciable quantities in the blood, while in the 
commencement of a fit of the gout there is a marked diminu- 
tion of it in the urine. "While on the abatement of the 
attack, the lithic acid or its compounds," says Williams, " ap- 
pears in increased quantity in the urine, that in the blood is 
diminished." 

This is the state of the blood and also of the urine, and the 
relation they bear toward each other in chronic rheumatism, 
and that such is the view taken by most writers, is evident 
from the fact of the treatment laid down by most of them 
being generally the same in both disases. 

" In gout," says Dr. Dick, " the urine previous to the attack 
and often during the severity of it, deposits uric acid, the 
urates of ammonia and soda, etc., and these salts, especially 
the urate of soda in combination with phosphate and carbonate 
of lime, when not sufficiently eliminated, are deposited in the 
cartilages and ligaments around joints, etc., and form what are 
called ' chalk-stones.'" This is after the same form as the 
concretions of rheumatism, and are to be removed by the same 
remedies. These concretions will be re-absorbed and removed 
in the form of uric acid in the urine, by a Lengthened OOUTSe 
of treatment, by colchicum, iodide oi' potassium, etc., or per 
haps by the administration of the 4 phosphate o\' ammonia, M 
recommended by Dr. Buckler, in rheumatism. 



GRANULAR KIDNEY 



This disease is characterized by a morbid deposit in the 
substance of the kidney itself, changing the appearance, and 
structure even, of that organ. The kidney loses its usual 
firmness, changes its color, becomes more yellow, and is some- 
times filled with an opake, white deposit, and finally the 
external becomes rough and scabrous, with projections innu- 
merable, of a yellow, red or purplish color, and not much 
exceeding in size a large pin's head. It is the same disease as 
that called " 3forbus Briglitii" the principal and distinctive 
feature of which is, the presence of albumen in the urine with 
a deficit of urea. The secretion of urine is somewhat scanty, 
high-colored, sometimes tinged with blood, and very highly 
charged with albumen. 

So universally has this latter substance ( which is not an in- 
gredient in healthy urine) been found in this state of the 
kidneys, that the disease has been called " albuminaria." 

From the albuminous urine being so generally connected 
with a dropsical state of the system, it may readily be sup- 
posed that there is a tendency to that state in this disease, 
which we find to be the case. In fact, this disease is generally 
complicated with dropsy, and sometimes makes its appearance 
in that form, even before we have had any other indication or 
notice of the real difficulty; and whether or not, of all the 
secondary consequences of granular kidneys, dropsy is the 
most frequent. 

To test the albuminous quality of the urine, if it becomes 
opake by heat, as also by the addition of nitric acid, both of 
which should be tried, it will be albuminous in extent ac- 
cording to the copiousness of the coagulation. The dingy- 
red appearance of the urine will lead to the suspicion of the 



Urino- Pathology. 227 



existence of blood therein, when, by dipping a piece of white 
linen into the vessel containing it, if blood be present, it will 
be tinged with red ; or, by the addition of alcohol, the urine 
will become lighter. 

The readiest and most convenient, and likewise the most 
infallible mode for detecting blood in the urine, where great 
exactness is desirable, is by the microscope. Allow the urine 
to repose in a tall glass, take a drop from the bottom of the 
vessel, and place it under the object-glass. (See Chart, Fig. 
11, CandD). 

Treatment has been very ineffectual in the generality of 
cases of this disease. Strict confinement to the bed, with the 
administration of small doses of turpentine, balsamic prepara- 
tions, with uva ursi, chimaphila ^umbellata, diosma crenata, 
trillium, conium. etc., are most likely to benefit. 



SPINAL DISEASE 



This disease generally proceeds from an injury, and is 
characterized by a high state of nervous irritability, pain over 
the lumbar region, with irritability of temper, etc. And the 
state of the brain and nervous system is so manifestly and mor- 
bidly irritable, that the secretions, and especially the urinary, 
produce irritability of their parts also. This irritability is 
generally sufficient to give rise to suspicions, and may be 
traced to some recent or remote injury to some part of the 
spinal column, either from a wrench of the back, blow upon 
the spine, or some previous sprain. 

The urine is generally more copious than usual, frequently 
pale, and of specific gravity below the average. The deposits 
are of the phosphoric kind, and almost exclusively of phos- 
phate of lime. It is always alkaline to test-paper. 

The fact of alkaline urine resulting from strains or blows on 
the back, was first noticed by Dr. Prout ; and injuries to the 
loins have long been enumerated among the exciting causes of 
renal calculi. 

" This alkaline state of the urine, and deposition of phos- 
phates," says Bird, "is a pretty constant result of anything 
which depresses the nervous energy of the spinal marrow, 
whether the result of insidious disease of the spine, or the 
effect of sudden mechanical violence." 

In injuries of the spine the urine is not only always alkaline, 
but the earthy phosphate is that of the phosphate of lime only. 
In other diseases of the nervous system and of the brain, there 
is generally the triple phosphates ; and if it be connected 
with dyspepsia, the oxalate of lime will be present ; for as in- 
juries to spinal marrow and dyspepsia may both afflict the 
patient at the same time, so may we find in this case the result- 



Urino-Pathology. 229 



ant phosphate of the one, and the oxalate of the other, in 
the urine at the same time ; and so in other complications 
of diseases. (For microscopic appearance, see Chart). 

By the presence then of phosphate of lime in the urine, are 
we enabled to confidently diagnose a case of injury to the 
spine ; and even although the injury may have been received 
during tbe existence of another disease, this mark of the 
urine will lead to the suspicion at last, that it is complicated in 
this way. 

An amusing story has often been related of an incident oc- 
curring in the practice of a celebrated Uroscopian physician 
concerning the detection of a case of injury to the spine by 
examining the urine, which runs thus : A gentleman, whose 
wife had been accidentally precipitated down a flight of stairs, 
thereby receiving serious injury of the spinal column, was per- 
suaded to carry some of the morning urine of his afflicted wife 
to the " water-doctor " for examination. Being somewhat 
incredulous as to the ability of the doctor to determine the 
case, with an air of coolness he presented the case, saying : 

" Here, doctor, is the urine of my wife. I want to see if 
you can tell me what ails her. Now, ask me no questions." 

The Doctor finding the urine to be strongly alkaline, and to 
contain abundance of deposits, of phosphate of lime, readily de- 
termined it a "spinal affection," proceeding, most likely, from 
injury by a fall, wrench, blow, or contusion of some kind, etc., 
to the silent astonishment of the husband. At length he re- 
marked : 

"Doctor, I see you know all; but some one has told you it." 

"Not at all," was the reply, "I know nothing of the case, 
only from the urine." 

"Well, then," thought he, "wc will try you a little farther,*' 
and he resumed thus : 

" Doctor, can you tell me how many steps she fell down \ 
answer that, and I will believe." 

Here was a poser. But here substituting subtility for sci- 
ence, the Doctor took another peer at the urinal, and prcs. 



230 Urino-Patliology. 



ing she might have fallen down the whole flight of stairs, 
guessed the number at ten. 

"Ah ha! you have missed it! I knew you couldn't tell 
anything," exultingly responded the husband; " why Doctor," 
said he, "she fell down the whole thirteen steps, from top to 
bottom." 

"Indeed! and did you bring all the urine she passed this 
morning?" asked the Doctor, (taking another peer at the 
urinal). 

"No, certainly not?" responded the husband. 

" How then do you expect me to tell the whole number of 
steps down which your wife was precipitated, without bringing 
it all along. You see, you left the other three steps at home" 
said the Doctor, in a seemingly ? angry tone. 

"I see, I see, it's all right, put up the medicine, and tell 
me your fee" — was the reply. 



BLOODY URINE. 



Whenever the elements of blood appear in the urine, there 
is ample proof of the existence of active or passive hemorrhage, 
either in the kidneys, bladder, urethra, or (in the case of a 
female) , from the vagina or uterus. 

Dr. Simon has given us some data whereby we may pretty 
nearly determine from which part the blood in urine may pro- 
ceed. He says: "Blood flowing from the urethra comes in 
drops; if the blood is discharged in masses after clear urine, 
it comes from the bladder, and in that case it often stops up 
the passage from the bladder by coagulation ; if the blood is 
distributed through the veins partly dissolved, and not in very 
large quantities, it comes from the kidneys; if it be dark 
and mixed with pus, it owes its origin to an ulcer." And we 
add, if it be mixed with mucus it is likely to proceed from the 
vagina or uterus ; and if, as mentioned in speaking of granular 
kidney, the urine contains albumen, it is from the kidneys also. 

Bloody urine may proceed from a laceration of the internal 
surface of the kidneys, bladder, or urethra, by mechanical vio- 
lence, in the passage of renal calculi ; or it sometimes is occa- 
sioned in the course of certain other disorders which affect the 
system more at large, as scurvy, etc., and at other times is 
a symptom of unpropitious moment in typhoid fever, and of 
considerable moment in small-pox, measles, etc., the disease in 
these cases will always be known by the characteristic combina- 
tion in the urine. (For microscopic appearance of the blood 
in urine, sec Chart, Fig. 11.) 

The microscope has often afforded valuable assistance to the 
pathologist, not only in a medico-legal point of view in de- 
tecting blood from colored fluids in eases oi % murder, but in 

distinguishing human, from other blood-corpuscles, in cases o\' 
imposition. 



232 Urino-Pathology. 



" Some years ago/' says Smith, " we were summoned to see a 
dyspensary patient laboring under bronchitis, who was spitting 
florid blood. On examining the sputa with the microscope we 
found that the colored blood-corpuscles were those of a bird. 
On my telling her that she had mixed a bird's blood with the 
expectoration, her astonishment was unbounded, and she con- 
fessed that she had done so for the purpose of imposition." 

Treatment : In bloody urine the treatment should be varied 
according to the part from which the blood proceeds, or the 
cause which produced it. Spirits of turpentine, balsamic pre- 
parations, gallic acid, vegetable astringent duretics, etc., are 
indicated. 



PURULENT URINE 



Pus often appears in the urine of persons laboring under 
suppurative inflammation of any part of the urinary apparatus, 
and sometimes is derived from abscesses of adjoining parts, 
which discharge their contents into the kidneys or bladder. It 
is said that the purulent contents of a diseased pleura even, 
have been known to escape into the kidneys and be discharged 
with the urine. 

Dr. G. Bird has given the characters of urine containing 
pus, in about as concise a manner as can well be done, which 
amounts to something like this : " Urine generally acid or neu- 
tral, unless long kept, and is always slow to assume putrefac- 
tive change; by repose, pus falls to the bottom, forming a 
dense homogeneous layer, of a pale-greenish cream-color, sel- 
dom hanging in ropes in the fluid like mucus does, and it be- 
comes, by agitation, uniformly diffused again through it. The 
addition of acetic acid neither prevents this diffusion, nor 
dissolves the deposits. When a drop of purulent urine is placed 
under the microscope, the particles become visible ; they are 
white, roughly granular, exteriorly, and are much more opake 
than blood-corpuscles. By close attention to the above facts. 
we will easily diagnose purulent urine, a matter of very con- 
siderable importance in many diseases. By agitating with 
ether, pus gives yelloAv, butter-like globules of fat : it is never 
a constituent of healthy urine, and affords diagnostic informa- 
tion of value, not otherwise easily obtained. (For microscopic 
appearance of pus in urine, see Chart, Fig. 13.) 



MUCOUS URINE. 



Mucus, in very small quantity, is so generally present in 
urine, that when there is merely sufficient to form a visible 
cloud, it is considered by some to be normal. But when it 
is found to be considerable in quantity, or to obtain in ex- 
cess in that fluid, an irregular, gelatinous mass, often entang- 
ling large air-bubbles, will be observed, which no agitation, 
however violent, can completely mix with the urine. This, 
of itself, is generally sufficient to distinguish the character of 
mucus from that of purulent urine, which it somewhat re- 
sembles, and the only kind with which it is likely to be con- 
founded. 

This state of the urine is always connected with an irri- 
tated or inflamed condition of the genito-urinary mucous mem- 
branes. Chronic inflammation of the bladder is a frequent 
source of this kind of urinary discharge, together with what- 
ever produces inflammation of the urinary organs, as cal- 
culi, etc. 

To distinguish it from pus by chemical test, add a little 
acetic acid, which will coagulate it into a thin, semi-opake 
corrugated membrane. Unlike pus, agitated with ether, mucus 
never gives but mere traces, if any, of fat. 

We have had a number of cases of mucous urine, some 
of which had been treated by eminent physicians for a long 
timej without benefit, which were soon relieved by our treat- 
ment. If the failure was the consequence of mistaken diag- 
nosis, which we believe, it is but another strong argument in 
favor of the Uroscopian system. (For microscopic appearance 
of mucus in urine, see Chart, Fig. 11). 



ANIMAL URINE. 



Many anecdotes are told, of the attempts at deception, 
practiced upon Uroscopian physicians, by presenting the urine 
of animals for inspection. Some persons are so ignorant as to 
to suppose, and even some physicians have asserted, that it is 
impossible to tell the urine of a man from that of a horse, 
cow, etc. This, however, needs no refutation, to those who 
can lay any claim to medical knowledge, as all medical men 
know that there is so wide a difference, both in appearance 
and constituents, that a mere optical glance would be suffi- 
cient to detect the attempted imposition, to say nothing of 
its strong odor, its microscopic appearance, or the reliable 
chemical tests. Anyone that has ever been far enough from 
home to pass the barn-yard, need not be reminded of the 
strong ammoniacal odor arising from the urinary products of 
the horse or the cow, and this alone should be sufficient olfac- 
tory tuition to satisfy one, on the first opening of the vial 
containing urine collected from these animals, of the absurd- 
ity of the attempt at such deception. 

The milky color, the specific gravity, loaded as it is with 
other salts not belonging to human urine, together with the 
chemical and microscopic examination, will never fail to de- 
tect it, even though a portion only of the specimen should 
be of the animal kind. 

Should chemical and microscopic examinations be requisite 
at any time, the large quantity of hippuric add contained 
in animal urine, and which is not an ingredient oi' that of 
human, will very readily determine the product. 

Evaporate a, small quantity to the consistence oi' sirup, 
then add an excess of hydrochloric acid, -when hippurio acid, 
if any, will fall to the bottom of the vessel in Large crystals, 



236 TJrino-Pathology. 



and may be examined by the microscope. ( See Chart, 
Fig. 6 ). 

Prof. Leibig gives an account of a girl laboring under hys- 
teria, who refused all food except apples, of which she de- 
voured an immense quantity. Her urine contained a large 
quantity of hippuric acid ; like the urine of a horse or cow. 

A neighbor physician, a curioso, by the way, being some- 
what chagrined at the success of his Uroscopian out-rival, 
undertook the foolish task of deception by presenting the 
urine of a horse, requesting an examination of the case, a 
written medical opinion, and of course, a prescription, if it 
was thought the patient required it. 

The Uroscopian proceeded to examine the specimen and 
was not long in detecting the imposition. He continued to 
prosecute the examination — chemically, by a number of ana- 
lytic tests, ond finally by close microscopic scrutiny, in each 
writing down the results ; and lastly, summing up his opinion 
and prescription thus : 

" Urine of an herbivorous quadruped. 

" Disease, Inanition ( emptiness). 

" Prescription : Cerealea, (sufficient quantity). To be given 
three times a day. 

" Charge : Twenty Dollars:' 

Slowly, but with determined look upon his customer, he 
rose to his feet, with pistol in hand, and presented the above 
prescription. Suffice to say, the bill was liquidated without 
demurring, and neigbor Dr. Curioso, went home a "satisfied" 
man. 



URINE OF PREGNANCY. 



We are often called upon to diagnose cases of pregnancy 
alone, or to decide between this and diseases in which ces- 
sation of the menses is involved. 

In general, there is hut little difficulty to determine a case 
of pregnancy by an examination of the urine alone, espe- 
cially if there is no disease in complication. When a female 
becomes pregnant her health generally improves, whatever it 
may have been before. The urine, therefore, in this im- 
proved condition, will be more natural in appearance and 
composition, than if there was suppressed menstruation from 
some other cause. And from whatever other cause such sup- 
pression may proceed, the characteristic mark of such cause 
will be exhibited in the urine, and be as a kind of negative 
sign. 

Suppression of menses with normal urine is a suspicious 
indication, but by no means a reliable one, unless the well- 
known principle called Jciestein y a constituent of the renal 
secretion of women during utero-gestation, be detected also. 

To describe the mode for its detection, although well known 
to practitioners generally, will not be out of place here. 

Ey allowing the urine of a pregnant woman to repose in 
a cylindrical vessel, a cotton-like cloud first becomes visible, 
" which in the lapse of time," says Bird, "varying from the 
second to the sixth day of exposure, becomes resolved into 
a number of opake bodies, which rise to the surface, form- 
ing a fat-like scum, remaining permanent for three or 
days. The urine then becomes turbid, and minute flocculi 
detach themselves from the crust and Bink to the bottom of 
the vessel; this action continues until the whole pellicle dis- 
appears." 



238 Urino-Pathology. 



It is distinguished from other kinds of pellicle, from its 
never becoming mouldy, or remaining on the surface more 
than three or four days. 

This investigation, carefully made, is one of the surest 
tests of pregnancy, and may be relied on with perfect con- 
fidence. 

Dr. Golding Bird experimented extensively in this way, 
with the urine of married and unmarried women, and with 
that of the pregnant and those not pregnant, and places great 
reliance upon it as a test of that state. 

A great number of writers have given attention to this mat- 
ter, and although some may differ in their views respecting the 
manner of formation of kiestein, its general presence in the 
urine of pregnant females is conceded. 

Griffith, Reese, Markwkk, Bowman, and a number of others, 
have laid down the same rule as above for its detection. And 
Dr. Griffith says : " With the exception of the peculiar fer- 
mentation which produces the kiestein, and the peculiar cheese- 
like odor, there are no characteristics of the urine in preg- 
nancy." 

Dr. Reese says : " There is a substance of a caseous character, 
called kiestein and gravidine, found in the urine of women 
during gestation." 

Dr. Markwick says : i; This substance (kiestein), is principally 
met with in the urine of pregnant women, in the form of a 
greasy, fat-like pellicle, which, after having remained stationary 
for a few days, breaks up and gradually falls to the bottom of 
the vessel." 

Dr. Bowman says : " The peculiar form of mucilaginous or 
caseous matter, usually present in the urine of pregnancy, and 
which has received the name of kiestein, gives the urine con- 
taining it a cloudy appearance, and, after the lapse of a few 
days, gradually forms on the surface in a more or less shining 
pellicle, which, in three or four days, as the urine becomes 
ammoniacal, breaks up into small particles and subsides at the 
bottom, etc." 



Urino-Pathology. 239 



When such men as the above, after having fully tested the 
matter, are so uniform in their opinions respecting it, we may 
be allowed to say, that we have examined a great number 
of cases in the same way, and can recommend it as giving 
satisfaction in every case so examined, where another disease 
has not so far altered the chemical qualities of the urine as 
to enshroud this substance. 

An amusing anecdote is told of a gentlemen residing in 
the country, who being himself somewhat indisposed for some 
considerable time, collected a specimen of his morning urine 
in a vial, for the purpose of obtaining the opinion of a Uros- 
copian physician upon his case, placing it upon the mantel 
in his chamber, until he should prepare to start. Breakfast 
over and his horse brought out, he pocketed the vial and was 
off. On arriving, he presented the vial to the Doctor, say- 
ing: "I want you to examine this case closely, and tell me 
all about it." The normality of the urine and the cotton- 
like cloud led the Doctor to suspect pregnancy, and, upon 
closer scrutiny, to pronounce more positively, that the pa- 
tient was enciente, certainly pregnant. The gentleman gave 
a derisive laugh. The Doctor persisted in his opinion. The 
gentleman gave a most contemptuous laugh, deriding the 
Doctor to scorn, declaring "the urine is my ewn," etc., 
whereupon he was booted out of the office. 

Returning home in a rather unpleasant mood, he there 
related the above-mentioned circumstances, dwelling especially 
upon the absurdity of the Doctor's opinion. The servant 
girl, who was at this time an unperceived but anxious 
tener, was soon observed bathed in tears. Upon inquiring 
the cause of her tears, she stated that she had emptied 
the vial on the mantel in the morning, and refill* 
her own urine. This explained all. The sanctity of her 
virtue had been invaded, and her condition was now fully 
known. Science had revealed to the Doctor a fact, which 

time only proved to he "tOO true" for the girl. 



SPERMATORRHEA. 



This disease is generally the result of a most degrading 
vice, and is one that produces consequences upon the human 
system, fearfully to be deplored ; not only merely because of 
the drain upon the nervous system, and the loss of the vital or 
nervous fluid in the semen, but also of that long train of ner- 
vous symptoms which it is likely to produce upon the body ; 
and the final reduction of the mental faculties which it so much 
and so soon debilitates. 

It is characterized, as its name indicates, by an excessive 
flow or discharge of the semen: and the animalcules called 
spermatazoa, are readily detected in the urine of a person 
afflicted with this disease. 

"In some cases, "says Bird, "a sufficient quantity of sper- 
matic fluid is found mixed with the urine, to form a visible cloud, 
and becomes an important guide to the practitioner in the inves- 
tigation of a case, perhaps previously and otherwise obscure/' 
The escape of semen is not always the result of bad habit, or 
the vice of self-pollution, but may arise from extreme constipa- 
tion, fatigue, paraplegia, excessive use of stimulants, etc. 
Urine containing spermatic fluid will be found cloudy and opa- 
lescent, and will redden litmus-paper. It maintains this cloudy 
appearance, whether by the application of heat or nitric acid, 
but the addition of nitric acid often produces a slight troubling 
in this kind of urine. It is sometimes as opake and thick as if 
mixed with gruel, and has a peculiar characteristic, fetid and 
nauseous odor ; but no characteristics can be given the urine, 
making it as distinctly diagnostic of the presence of semen, as 
may be assumed in the examination by the microscope, al- 
though should a large quantity of that secretion be present in 
the urine, it can generally be recognized by these physical 
characteristics. 



Urino-Patho loyy. 241 



For microscopic examination, let the urine repose in a glass 
vessel for a short time, decant all the fluid except the last few 
drops, place one of these on a slip of glass, cover it with a 
piece of mica and place under the field of the microscope : 
" The spermatazoa will be observed as minute, ovate bodies, 
provided with a delicate bristle-like tail, which becomes more 
distinct on allowing the drop of urine to dry on the glass," 
says Bird, " and that the detection of spermatazoa in the urine 
will often enable the physician to discover a source of exhaus- 
tion previously concealed from him, and baffling his treatment, 
is unquestionable." 

The discovery of spermatazoa on the person or clothing 
even of the subject, has been made a test in medico-legal in- 
vestigations, for the proof of rape. When found on the per- 
son of the subject it is conclusive evidence, if not that a rape 
had been committed, at least that emissions of a male had oc- 
curred, and would go far as corroborative testimony in the 
case. (See Chart Fig. 12, C). 

Treatment: Abstinence from exciting causes, stimulants, 
etc. Aperients, cold hip-baths, bromide of potassium, catkins 
of willow, lupulin and camphor, digitalin, etc., have all been 
recommended. Cauterizing the seminal ducts, is recommended 
by Lallemand. Much will depend on the influence over the 
moral feelings, exerted by the patient himself; without which 
favorable influence, medicine alone is useless. 



TORULA, 



When urine contains even a small amount of sugar, too 
little even to cause it to assume a diabetic character, certain 
phenomena are developed which will at once point out the 
presence of that substance. 

"When this kind of urine is left in a warm place, a scum 
soon forms on its surface, as if a little flour had been dusted 
on it. This consists of small oval vessicles containing in their 
interior, minute granular corpuscles, which expand and become 
tubular, and finally put on a beaded or jointed appearance. 
These are colled torulce. (See Chart, Fig. 12). They are only 
met with in saccharine urine while undergoing alcoholic fermen- 
tation. The tests for this kind of urine are more fully given 
under the head of Diabetes, as in that disease the greatest 
abundance of saccharine matter is found in the urine. We 
will, however, here insert the directions for the application of 
" Moore's test": 

"Place in a test-tube, about two drachms of the suspected 
urine, and add nearly half its bulk of liquor-potassa. Heat 
the whole over a spirit-lamp and allow actual ebullition to con- 
tinue for a minute or two ; the previously pale urine will be- 
come an orange-brown, or even a blister tint, according to the 
proportion of sugar present."' IKseases in which torulae are 
found are, diabetis mellitus, with great lassitude and deficient 
sexual appetite. The urine is generally passed in very large 
quantities, and is apt to be deficient in urea. 



VIBRIOSES. 



These are minute animalcules, which are occasionally met 
with in the pale, light urine of cachectic and debilitated 
persons. " All the urine in which we have found these minute 
creatures," says Bird, "has been pale, neutral and of low 
specific gravity, and rapidly underwent putrefactive fer- 
mentation. When a drop of such urine is examined with 
the microscope, it will be found full of minute, linear bodies, 
moving with animation." They have an oscillating motion, 
"strong enough to excite tolerably rapid currents in the 
fluid." (See Chart, Fig. 9 C). They are only met with, in the 
urine of persons in an excessively low and depressed state. In 
some scrofulous cases, of extreme prostration, in which the 
powers of life are fast ebbing away, or in greatly debili- 
tated cases of syphilitic disease, where there is extreme 
prostration of strength, they are more abundantly developed. 
In fact, in these latter cases, their appearance in the urine 
may be considered as the characteristic of that state. 

Alteratives, chalybeates, and stimulant tonics, would seem 
to be the only course of treatment that would be of service. 
Sea-bathing and fresh air, where the patient is able to stand 
the exercise, might be assistants to medication. Some saline 
diuretics might be of much benefit, " as there can be no 
doubt," says Dr. Millington, "that the kidneys are glands 
for draining away that from the blood which would be detri- 
mental to its action if it remained in it, and which ifl not 
simply water, but often other matters that lead to disease." 



CANCER OF THE WOMB. 



Cancer is a vascular, morbid production, characterized 
by a form of organic cell, which is peculiar, and never enters 
as a constituent in any normal tissue. 

It is a hard tumor, which ultimately terminates in a pe- 
culiarly fetid and ichorous ulcer. It requires for its pro- 
duction a peculiarly cachectic condition, and occurs generally 
in those patients only who may be considered as having a 
cancerous diathesis. "Very great difficulty has often been 
experienced in arriving at an accurate opinion as to the 
cancerous or non-cancerous nature of a tumor, and it is only 
by carefully noting the collective appearances observed, upon 
a microscopic examination, that we shall be enabled to de- 
cide," says Dr. Beale. But Dr. Donaldson asserts positively 
that "true cancer can be distinguished from every other 
tissue, normal or pathological, by certain clear and well- 
defined elements," among which "its lactescent, infiltrated 
juice, is very characteristic. The presence of this peculiar 
fluid is of itself a point of differential diagnosis of great 
value, the microscope always detecting in it, when found, 
the presence of cancer-cells," etc. 

Anyone at all acquainted with the sanious ichor secreted 
from a cancerous surface, and the peculiar odor arising 
therefrom, would not be long, at least, in suspecting it, from 
the very offensive smell itself. 

" The odor which attaches itself to it, is alone sufficient, 
in forty-nine cases out of fifty to establish a diagnosis," says 
Bennet. "More especially is this the case in the horribly 
offensive odor of a cancerous uterine discharge. It is so 
peculiarly nauseating, as to leave a lengthened impression 
on the olfactory nerves, the least portion of which excreted 
in the urine will be readily discovered." 



Urino-Pathology. 245 



In cancer of the uterus, the microscopic examination of 
the discharges becomes highly important in arriving at an 
accurate diagnosis. "Cancer-cells, in such cases, may often 
be detected in the discharges,'' says Carpenter. The micro- 
scopic appearance of these cells from the uterus is repre- 
sented in Chart, Fig. 15 C, as they are observed in the 
urine of such patients. 

The caudated cancer-cells, as represented in Chart, Fig. 
16 A, are of common occurrence in cancerous tumors, and 
in cancer of the bladder are invariably present. Therefore 
they should be carefully examined. The concentric cancer- 
cells, as represented in Chart, Fig. 16 B, are those of can- 
cer of the breast, ovaria, etc., and deserve to be closely 
scrutinized and well understood, in order to form a correct 
diagnosis. It is in uterine cancer that the microscopic in- 
spection of the urine overrides in value all the other means 
for correct diagnosis. 



LEUCORRHCEA— (Whites). 



This disease affects the mucous membrane of the vagina 
and uterus, the principal local symptoms of which are the 
pouring out of an unhealthy secretion, or an unnatural, dis- 
charge, of a vrhitish, opake, or sometimes, yellowish or even 
greenish color. Most writers include this latter color under 
gonorrhoea, hut this is highly improper, where the true gon- 
orrhoea! virus' does not exist, as the pathological conditions of 
the parts in the two diseases are entirely different. There is 
frequently a great similarity between them, however, and much 
mischief and injury may be occasioned by want of proper dis- 
crimination. 

The leucorrhceal discharge is more like jelly and is gener- 
ally whiter than in gonorrhoea, and comes, as before remarked, 
from the vagina and uterus, while the seat of gonorrhoea is 
more generally in the urethra, and the discharge of a more 
specific, contagious character. 

Uterine and vaginal discharges present somewhat different 
characters in different specimens. Mucus, pus, blood, and epi- 
thelium, from leucorrhcea, is represented from a microscopic 
examination, in the Chart, Fig. 14. 

" In leucorrhcea many of the epithelial cells are filled with 
oil-granules, and mingled to a greater or less extent with pus- 
corpuscles." 

By microscopic examination of a drop of the urine con- 
taining it, the leucorrhceal discharge may be more readily dis- 
tinguished from gonorrhceal than by any other means. 

Vaginal epithelium is always of the scaly variety, and con- 
sists of large, flat, ragged, and very irregular cells, folded over 
each other, and perhaps creased in different directions. 






GONORRHOEA— (Clap) 



This disease is characterized by a discharge from the mu- 
cous membrane of the urethra, produced by contagion from 
a similar discharge during sexual connection. 

This matter is generally, or always, of a yellowish or green- 
ish color, and is of a highly contagious character. Although 
this virulent poison may produce gonorrhoea on the mucous 
surfaces of the body, as the eyes, nose, etc., it is pretty gen- 
erally confined to the urethra, producing a considerable de- 
gree of pain and scalding heat, in passing water. In addi- 
tion to the gonorroeal matter which is discharged from the 
urethra, there is sometimes a tinge of blood in the urine 
also. 

Although this disease may generally be quite correctly di- 
agnosed in the male subject, a great difficulty is sometimes 
experienced in distinguishing it from leucorrhcea, in females. 
Great injury might be done, both to the character and con- 
stitution of the patient, by a mistake in the diagnosis. There- 
fore great caution is required of the physician, lest by a 
mistake in the diagnosis, he might cast reflections on the 
continence of a chaste woman, and hazard his reputation and 
property, by incurring a suit for mal-practicc. 

" That medico-legal science has been greatly enriched and 
rendered far more certain in its results by the aid of the micro- 
scope, few persons will deny," says Carpenter. k - The ends 
of justice sometimes depended solely upon its power of de- 
tecting spcrmatazoa, in the case of rape, of distinguishing 
between the stains of blood and those of colored fluids, or 
of pointing out the difference between human hair, and that 
of animals," etc. 

And in the microscopic examination o\ the discharge in 
this disease, the most convincing proofs are obtained. " Tin- 



248 Urino-Pathology. 



peculiar appearance of the epithelial cells," says the above 
author, " will indicate the part of the genito-urinary mucous 
membrane from which the mucus or pus was secreted." ( See 
Chart, Fig. 11, F). 

The peculiar yellowish or greenish color of the purulent mat- 
ter in gonorrhoea, together with the above-mentioned epithe- 
lium, will enable anyone to detect and discriminate between 
this and the preceding disease. 

Urine mixed with the matter of gonorrhoea is always acid 
to test-paper. An alkaline wash to the parts, with alkaline 
diuretic salts would therefore be appropriate treatment, in 
connection with medicines to destroy the specific, contagious 
virus. 

Balsam of copaiba has long been in great use, but is not 
alone to be relied on. Podophyllin, irisin and phytolaccin, 
in connection with the alkaline treatment, will be good. 



SYPHILIS. 



This disease is always produced by a specific poison, the 
smallest particle of which is sufficient to bring on the disease 
in all its virulence. 

This poison is imbibed by the blood and transmitted through 
the stream of life, until sooner or later, the entire mass be- 
comes affected, and the whole body contaminated with the 
disease. 

" It is a well-known law of animal poisons," says Wilson, 
" that being once introduced into the blood, they excite in that 
fluid an action which has for its object the production of a sim- 
ilar poison, and this process goes on until the blood becomes 
saturated or overcharged with the morbific principle." 

The poison of syphilis having once entered the system, it 
is hard, if even possible, to ever thoroughly eradicate it. At 
all events, it remains for years, and sometimes for life, giving 
notice of its existence from time to time, perhaps, by a variety 
of symptoms, more especially if an appropriate and thorough 
course of medication has not been promptly meted out at the 
onset almost of the disease. 

The urinary secretion will early give evidence of this poison- 
ous matter, as this is one of the great emunctories whereby 
poisons are eliminated from the animal economy. 

In a short period of time, the whole system becomes dis- 
turbed by this innoxious principle of the blood, and all the 
organs and structures supplied with that blood must suffer, to a 
greater or less extent, and the disease becomes a constitutional 
one. 

In this peculiar cachectic state of the system, the urine is 
pale, but not clear, neutral in its oharaoter, of low specific 
gravity, and very rapidly undergoes putrefactive fermentation. 



250 Urino-Pathology. 



When excessively debilitated from this cause, a drop of 
urine examined under the microscope, will exhibit a great 
number of minute, linear bodies, called "vibriones." (See 
Chart, Fig. 9, C). "These have an oscillating motion," says 
Bird, " strong enough to excite tolerably rapid currents in the 
fluid." 

This is essentially the characteristic of syphilitic urine, and 
may be seen in the urine of even less-developed cases of syph- 
ilis, but is ahvays to be found in that of the extremely debil- 
itated, or prostrated from that cause. 

Treatment : Alteratives, chalybeates tonics, and stimulating 
diuretics, are indicated in all such cases. 



HEADACHE. 



THIS frequent and distressing disease, although apparently 
arising from different causes, yet seems to be dependent 
upon some peculiar condition or action of the blood. A marked 
derangement of the stomach produces its effect upon the 
circulatory system, a recession from extremities or some other 
part, and a determination of that fluid to the head follows. 

"In a majority of cases where persons are subject to fre- 
quent returns of headache," says Prof. Newton, "we are sat- 
isfied that the cause is deficient secretion of the solids of the 
urine." 

We have noticed in such cases that the urine was secreted 
in small quantity, and was of low specific gravity previous to, 
and at the time of the attack. 

Such headache becomes more or less periodic, frequently, 
and requires to be treated with antiperiodics, in connection 
with diuretics, podophyllin, leptandrin, valerianate of quinine 
and iron, with acetate of potassa, etc. 

Dr. Simon says: "Now, it is a common observation that al- 
most all headaches are most promptly relieved by whatever 
stimulates the kidneys to throw off a quantity of urine. When 
this takes place the system feels at once relieved of a load or 
oppression which seems to clog all its energies, and the mind 
as well as the body, becomes more light and vivacious." 

With the improvement in the urinary secretion will the relief 
of the disease be manifested. 



DENTITION. 



The following remarks on the above subject, by Dr. Simon, 
we have thought worthy of a place here. Dr. Simon prefaces 
them by alluding to the frequent inactivity, and sometimes the 
almost complete suspension of the functions of the kidneys, 
etc., while the system of the child is suffering severely from 
dentition. 

" The simple question as to the quantity and color of the 
urine (and by the way, we can much better trust the report of 
nurses about the state of the urine than we can about the 
alvine evacuations), will often enable us to at once form a cor- 
rect opinion as to the general or constitutional health of our 
patient. As long as the kidneys act freely, there is little or no 
risk in the symptoms of mere dentition, however severe and 
distressing the signs may be. 

" The same remark is, we believe, strictly applicable to the 
prognosis of most cerebral affections in children. When the 
urinary secretion is scanty and deep-colored, the circulation 
seems to be oppressed and excited ; and the rapid, on some 
occasions, almost instantaneous mitigation of the alarming 
symptoms, after a copious discharge of water, is well known to 
all experienced practitioners. 

" On the whole, we do not think that there is a more impor- 
tant sign to be attended to in the management of children, 
during the first two years of their life, than that afforded by 
the state of the urinary secretion. 

" In fine, the kidneys become, in numerous cases of dis- 
ease, the seat of an active, eliminatory process, of which 
the skillful physician will avail himself in the treatment of 
dentition, and of various other affections, to which children 
are especially liable during the first two years of their lives." 



Urino-Pathology. 



We have given the above, both for the practical remarks 
it contains in favor of the urino-pathology, or the "Uros- 
copian System," as well as the value of such investigations in 
the treatment of dentition. 

If it be true, that almost all headaches are promptly re- 
lieved by a free discharge of urine, as observed in the article 
on that subject, how important the examination of that dis- 
charge must be in all cerebral affections, and how derelict 
in duty would be the physician, who, through ignorance or 
neglect, would not avail himself of the knowledge necessary 
for the prompt relief of these little sufferers. 

If the irritation of dentition, however, is as yet confined 
to the stomach, the urine will usually be pale and abundant, 
depositing a whitish or yellowish-white sediment. 



WOEMS. 



The troublesome complaints among children, occasioned by 
worms, are many times difficult to distinguish from other 
diseases by the ordinary mode, and frequent mistakes occur 
in the treatment of children, for want of a proper diagnosis, 
the little patients being harassed with a long course of me- 
dication for infantile remittent fever, or some other disease, 
when worms only were the first cause of illness ; or drenched 
with nauseating "vermifuges," when the patient was labor- 
ing under disease of a more formidable character, and in 
which these medicines were productive of the worst conse- 
quences. 

Every intelligent mother, however, who has had any ex- 
perience in rearing children, is enabled to form some idea 
of the state and appearance of the urine in these cases, and 
will describe it as being sometimes thick and yellowish, or 
more generally of a milky-white color. So almost univer- 
sally is this appearance of the urine observable in a case of 
worms, that upon this alone the little patient is many times 
very correctly hurried off to the physician, before any other 
symptom is discoverable, when, if properly treated, the more 
serious consequences of convulsions, etc., are averted. 

How important, then, that the physician himself should be 
enabled to distinguish these cases, and not leave it alone to 
the nurse to decide. 

Professor Eberle, however, says: "In worms the urine is 
turbid, yellowish — or, after depositing a sediment, has the 
appearance of milk and water." 

Professor Beach says : "The urine is pale, thin, crude, and 
in some instances the color of whey, or quite white." 



Urine-Pathology. 255 



Prof. Payne, says: " There are frequent changes in the ap- 
pearance of the urine, which is at one time thin, scanty and 
of a milky appearance, and at another copious and limpid." 

A little attention to the urine in worms will enable anyone 
to distinguish it almost at first sight, by its pale, light, milky- 
white, yellowish tinge, or whitish color. And every physi- 
cian should acquaint himself with the characteristics thereof, 
that intelligent and appropriate remedies may be administered. 
This appearance of the urine, however, is met with only in 
cases of children troubled with lumbricodes, or taenia solium. 

We have in our possession several large pieces of tape-worm 
which were expelled by our treatment, the diagnoses having 
been made out by an examination of the urine alone — one of 
the patients being an adult, had been treated for nearly every 
disease but worms, before coming under our professional care. 
But with this characteristic of the urine you need never mis- 
take a case of these kind of worms. 

There are other kinds of worms, however, that infest the 
human body ; and that are to be discovered in the urine, or by 
their marks in that fluid. The strongylus gygas, sometimes 
occupies the human kidneys, and causes great suffering. We 
observed one of these parasites that had been expelled from a 
patient of Prof. E. G. Dalton, of the Eclectic Medical College 
of Philadelphia. It was several inches in length, and was 
passed from the urethra. The dactylitis acirfeatus, was first 
described by Curling — who discovered several of them in the 
urine of a little girl. 

A patient of M. Lawrence, voided numbers of the parasites, 
diplosma crenata, for a length of time, from the urinary blad- 
der. 

Also, the spiroptera hominis, was discovered in tho urine, 
by Mr. Lawrence. 

The most beneficial or generally successful treatment for 
the removal of lumbricodes will be found in the following: 

Pulverized Santonin twelve, Pulverized Podopbyllm two 



256 Urino-Pathology. 



grains. Divide into twelve parts, and give one morning and 
evening to a child two years of age. 

For tape-worm, pumpkin-seed, orgeat and spirits of turpen- 
tine, has succeeded best in our hands. 

The other kind will require a more diuretic medicine. 



DYSUR1A— (Of Infants) 



This complaint is very frequent among infants, and is often- 
times overlooked or passes unnoticed, because of the inability 
of the little sufferer to make known the seat or location of 
the excruciating pain, which is manifested only by shrieks. 

This painful affection in voiding urine, is always attended 
with an unnatural condition of the urinary secretion, and 
humanity alone should prompt the physician to use every 
means to discover the true cause of suffering, more especially 
where innocence is the sufferer, and infancy prevents the 
communication of the facts. 

" In a majority of these cases the urine contains a large 
portion of lithic acid," says Eberle, " and, occasionally, it is 
highly charged with phosphoric, sedimentous matter. These 
substances impart a peculiarly irritating quality to the urine, 
and, when they are copious, and the system is in an irrita- 
ble condition, may readily produce a considerable degree of 
irritation about the neck of the bladder, and give rise to pain 
and difficulty in passing urine." 

When a child becomes affected with pain and difficulty in 
passing urine, this secretion ought to be carefully examined, 
both in a recent state, and after it has stood for some time. 
If the sedimentous matter of the urine be of a red, or red- 
dish color, remedies calculated to counteract the secretion of 
lithic acid by the kidneys, will be indicated, and will proba- 
bly procure speedy relief. 

Dr. Prout observes that children, in general, and especially 
those of dyspeptic or gouty parents, or who inherit a tendency 
to urinary diseases, are exceedingly liable to litliic-acid de- 
posits in the urine. If the urine be examined it will always 
be found to be very unnatural, and frequently leaded with 



258 Urino-Pathology. 



lithic acid ; and should this prove to be the fact, the case 
requires immediate attention, as there is much greater risk, 
at this period of life, than at any other, for the formation of 
stone in the bladder. 

In this condition of the urinary secretion, the administra- 
tion of small doses of magnesia, bicarbonate of soda, sub- 
carbonate of potash, lime-water, etc., 'would be peculiarly 
suitable medicines, in connection with some mucilaginous 
drinks, such as flaxseed tea, althaea officinalis, etc. 

The common Neutralizing Cordial of Dr. Beach's work, is 
very valuable in these cases, because of its alkaline proper- 
ties, and peculiarly acceptable stomachic in all diseases where 
acid in the alimentary canal predominates — children who are 
much affected with acidity in the prima vice, being most apt 
to experience urinary difficulties of this kind. 



ENEURESIS. 



This disease may be occasioned by the same faulty state 
of the urine, as in dysuria, and in fact there is many times 
no real or apparent difference, farther than the mere external 
symptom of discharging the urine during sleep at night in 
the one, and the greater degree of pain in voiding it, in the 
other. 

Prof. Eberle says : " Incontinence of urine very frequently, 
perhaps always, in the first instance, is excited by an acrid con- 
dition of the urinary secretion itself. In those cases, especially 
where the discharge takes place in consequence of involun- 
tary effort excited by a lively dream, the urine almost always 
contains an excess of sedimentous matter, particularly lithic 
acid and its compounds, imparting to it an irritating char- 
acter." 

" Hence," says Dr. Prout, " we have been led to infer that, 
in this species of urinary incontinence, the acrid properties 
of the urine are chiefly at fault." He also thinks that some 
peculiar morbid condition of the urinary organs constitutes 
the most frequent cause of those cases of nocturnal inconti- 
nence of urine, in which the discharge takes place involunta- 
rily, and without any consciousness of its occurrence also. 

" From what has been said above," says Eberle, " it need 
scarcely be observed that, in prescribing for a case of this 
kind, particularly when of a recent character, the urine ought 
to be carefully inspected, as a preliminary step in the adop- 
tion of a suitable plan of management. Should the urine be 
found to contain much sedimentous matter, remedies ought 
to be employed for correcting the urinary Becretion. If the 
lithio-acid deposits predominate, small doses of magnesia, lime- 
water, the subcarbonate of potash, or of the bicarbonate of 
soda, should be resorted to," etc. And in cases attended v 



260 Vrino-Pathohgy. 



phosphoric urinary deposits, remedies calculated to counteract 
the formation of these should be employed, such as vegeta- 
ble acids, acescent articles of nourishment, etc. By such a 
course of management, recent cases especially may be com- 
pletely arrested. 

" Incontinence of urine in children sometimes depends upon 
a morbidly irritable state of the bladder. The patient during 
the day is more or less harassed with a frequent desire to 
urinate, and the discharge is always accompanied with con- 
siderable uneasiness, and sometimes with much pain. These 
cases are usually associated with a morbid condition of the 
urine, also ; sometimes with an excess of lithic acid, and occa- 
sionally, with phosphoric deposits. Instances of this kind 
must be managed in the way stated above." 



IISTDEX. 

♦♦ 

Acids — in the Body, 20 

Acidity of Urine — Tests fcr, 78 

Albumen,.... 19, 31, 43, 62 

Alkalinity of Urine, 78 

Animal Sugars, 20 

Animal Urine, 235 

Anemia, 50 

Analyses of Urine — Simons, 71 

Apoplexy— Blood and Urine in, 207-8 

Apparatus — for Testing Urine, 79 

Bile, 46 

Bloody Urine, 231 

Blood — Saline Matters in, 45 

" Foreign Matters in, 47 

u Standard Constituents of, 59 

" Black in some Fevers, 61 

Blackall — on Dropsy, 62 

Bladder — Inflammation of, 119 

" Urine in, 120 

Bowels — Inflammation of, Ill 

" Urine in, 112 

Brain — Inflammation of, 92 

" Blood and Urine in, 93-4 

Buchanan, Dr., 72 

Cancer-Cells, 33-4 

Cancer of the Womb, 244 

Casein, 19 

Chart — Manner of Using, 26 

Changes in the Blood by Bespiration, 45 

Chemical Analysis of Urine, 24 

Chorea, 218 

Chloride of Sodium— Fig. 2, 28 

Chlorosis — Blood and Urine in, 185-6 

Chronic Rheumatism, 222 

Coloring Matters in Blood and Urine, L9-22 

Congestion, 

Constituents of Healthy Urine, 7 ! 

Consumption — Blood in, 171 

" Urine in, 1*72-3 

Cystine, 20, 3 1 

Cystitis, 119 

Definition of Disease, 

Dentition, 

Delirium Tremens, 211 



262 Index. 



Determination of Blood, 51 

Deposits on Textures, 56 

Diabetic Sugar, 32 

Diabetes — Blood and Urine in, 188-9 

Disease — First in the Blood, 66 

Dropsy — Blood and Urine in, 175-7 

" ' After Scarlatina, 179-80 

Dyspepsia — Blood and Urine in,.: 197-9 

Dysuria, 257 

Ear — Inflammation of, 96 

" Urine in, 97 

Eneuresis, , 259 

Effusion, 53 

Epilepsy,.. 209 

Extractive Matters, 19 

Examination of Urine, 22 

Explanation of Chart, 28 

Exudation, 53 

Erysipelas — Blood and Urine in, 159-60 

Fats, 20, 33,44 

Fever, Inflammatory, 85-8 

Fevers in General, 126-8 

" Intermittent — Blood and Urine in, 129-30 

" Remittent. " " " 133-4 

" Typhoid, ' " " " 139-42 

" Yellow, " « 144-6 

" Puerperal, " " " 147-9 

" Scarlet, " " " 150-2 

Fibrin, ' 19, 42, 63 

Gangrene, 54 

General Principles, 35 

Gonorrhoea, 247 

Gout, 225 

Granular Kidney, 226 

Headache, 251 

Healthy Urine, 74 

Heart — Inflammation of, 103-4 

Hematosin, 23 

Hippuric xlcid in Urine, 20, 22 

Herpes Zoster, 161 

Hydrothorax. 181 

Hydrocephalus, 183 

Hypochondria — Blood and Urine in, 214-15 

Hy peremia, 49 

Hypertrophy, 55 

Hysteria— Blood and Urine in, 212-20 

Incidental Constituents of Body, 18 



Index. 263 



Induration , 54 

Inflammation, f 52 

Inflammatory Fever — Blood and Urine in, 84-8 

Inflammation of Brain — Urine in, 22-4 

" Ear, " 96-7 

" Lungs, u 98-9 

" Heart, " 103-4 

" Liver " U 

11 Stomach, " 109-10 

" Bowels, " 111-12 

" Kidneys, « 114-15 

« Womb, " 117-18 

Bladder, " ...119-20 

Inflammatory Rheumatism — Urine in, 12 1-4 

Intermittent Fever, " 129—31 

Introduction, 7 

Jaundice, " 194-6 

Kidneys—Their Office, , 68-70 

" Inflammation of, 114 

Granular, 226 

Lactic Acid, 20 

Leucorrhceal Matters, 33 

Leucorrhoea, 246 

Liver — Inflammation of, 106 

Blood and Urine in 107-8 

Liver-Complaint, " " 191-2 

Lungs — Inflammation of, 106 



" " Blood and Urine in, 107-8 

Measles — Blood and Urine in, 164 

Mineral Constituents of Animal Bodies, 17 

Mucus, 32 

Mucus Urine, 2:5 4 

Nutrition, 54 

Nervous Diseases, 202 

Optical Examination of Urine, 22 

Organic Constituents of the Body, 18 

Oxalate of Lime, 20, 80 

Ovarian Dropsy, 184 

Paralysis, 216 

Perspiratory Secretion, 16 

Pemphigus, 163 

Phosphates in Urine, 162 

Plethora 

Poison in Blood, 

Pregnancy — Urine in 287 

Proteon — Its Compounds., IS 

Properties of Blood, 41 



264 Index. 

Purulent Urine, » 233 

Purpurine — of Urine ; 23 

Pus, 33 

Recommendations, 3 

Red Globules, 59 

Remittent Fever — Blood and Urine in, t 133, 4-5 

Rheumatism Inflammatory, u 120-3 

" Chronic, " " 222-3 

Saccharine Diabetes, 47 

Saline Matters, in Blood, 45 

Scarlet Fever — Blood and Urine in, 151-2 

Scorbutus — Blood and Urine in, 164-5 

Scrofula, « « 167-9 

Shingles, " " ; 160-1 

Small-Pox, « « 156-7 

Specific Gravity of Urine, 74 

Spermatorrhoea, 240 

Spinal Disease, : 228 

Standard of Healthy Blood, 59 

" " " Urine, 74 

Stomach — Inflammation of, 109 

Syphilis, 249 

Tests for Urinary Deposits, 78-79 

Torulse, . 242 

Typhoid Fever— Blood and Urine in, 133, 140-3 

Urate of Ammonia, 29 

Urea, 19, 28, 61, 63 

Uric Acid, 20, 29 

« Oxide, ..20 

Urino-Pathology, 17 

Urine, 69 

" Constituents of Healthy, 74 

" Animal, . 235 

" Mucus, 234 

« Purulent, ..233 

Urinometer — Description of, 77 

Uterine Cancer-Cells, 34 

Vesicular Fever, 163 

Vibriones, 243 



Water in Blood, 45 

" " Urine 80 

Waters — Difference in, 71 

Womb — Inflammation of, 1 17 

" Cancer of, ~* v - 244 

Worms, / ...J&L 254-5 

Yellow Fever, i...^,., 144, 5-6 

" Blood aad chaue in,. v . 146 









